M1473 HCPCS Level II code: Patient situations, at any point during the denominator identification period, where the patient's functional capacity or motivation (or lack thereof) to…
M1473 is the HCPCS code for “Patient situations, at any point during the denominator identification period, where the patient's functional capacity or motivation (or lack thereof) to improve may impact the accuracy of results…” in CMS’s October 2026 release, in effect from Oct 1, 2026.
Official description
M1473Patient situations, at any point during the denominator identification period, where the patient's functional capacity or motivation (or lack thereof) to improve may impact the accuracy of results of validated tools, such as delirium, dementia, intellectual disabilities, and pervasive and specific development disorders
Short description: Pt func cap not allow impr
HCPCS · United States
Medicare details
The indicators CMS publishes with M1473 in its October 2026 file. They describe Medicare’s handling, not another payer’s.
- Medicare coverage
- Carrier judgment
- Medicare pricing
- Service not separately priced by Part B (e.g., services not covered, bundled, used by Part A only, etc.)
- Type of service
- Medical care
- BETOS category
- Undefined codes
- Added
- Jan 1, 2026
Where M1473 sits
- 1M codesMedical services and quality measures
- 2Active code M1473Patient situations, at any point during the denominator identification period, where the patient's functional capacity or motivation (or lack thereof) to improve may impact the accuracy of results of validated tools, such as delirium, dementia, intellectual disabilities, and pervasive and specific development disorders
Source and release
- Data release
- HCPCS Level II · October 2026
- Effective date
- Oct 1, 2026
- Publisher
- CMS
This page is built from the HCPCS Level II catalog that Vero Codes reads when it suggests codes: Centers for Medicare & Medicaid Services’s October 2026 release, imported from the publisher’s file and checked against it. The description, notes and structured data come from the same record.
Frequently asked questions
What does HCPCS code M1473 mean?
M1473 is the HCPCS code for “Patient situations, at any point during the denominator identification period, where the patient's functional capacity or motivation (or lack thereof) to improve may impact the accuracy of results of validated tools, such as delirium, dementia, intellectual disabilities, and pervasive and specific development disorders” in CMS’s HCPCS Level II October 2026 release.
Does Medicare cover M1473?
CMS lists M1473’s Medicare coverage as “Carrier judgment” and its pricing as “Service not separately priced by Part B (e.g., services not covered, bundled, used by Part A only, etc.)”. Coverage and payment still depend on the patient, the setting, the documentation and the payer.
Which HCPCS Level II release does this page use?
It uses CMS’s October 2026 release, in effect from Oct 1, 2026 to Dec 31, 2026. It is a reference: confirm the code against the current list and the payer’s rules before you submit it.
Codes beside M1473
All M codesM1467Patients with an existing diagnosis of lynch syndromeM1468Patient received recommended doses of hepatitis b vaccination based on ageM1469Patient has a history of hepatitis b illness or received a hepatitis b surface antigen, hepatitis b surface antibody, or total antibody to hepatitis b core antigen test with a…M1470Documentation of medical reason(s) for not administering hepatitis b vaccine (e.g., prior anaphylaxis due to the hepatitis b vaccine)M1471Documentation that patient is a medicare fee-for-service beneficiary and without additional supplementary insurance coverage for whom hep b vaccination is not reimbursable under…M1472Patient did not receive recommended doses of hepatitis b vaccination based on ageM1474Patients with diagnosis of dementiaM1475Patients with diagnosis of huntington's diseaseM1476Patients with diagnosis of cognitive impairment or alzheimer's diseaseM1477Diagnosis of deliriumM1478Psychoactive substance abuseM1479Patients whose functional capacity or motivation (or lack thereof) to improve may impact the accuracy of results of validated tools such as delirium, dementia, intellectual…