M1497 HCPCS Level II code: Documentation of falls not performed due to medical reasons (e.g., syncope, vertigo and related disorders, restless leg syndrome, tourette syndrome/tic…
M1497 is the HCPCS code for “Documentation of falls not performed due to medical reasons (e.g., syncope, vertigo and related disorders, restless leg syndrome, tourette syndrome/tic disorder, back pain, concussion/mild traumatic…” in CMS’s October 2026 release, in effect from Oct 1, 2026.
Official description
M1497Documentation of falls not performed due to medical reasons (e.g., syncope, vertigo and related disorders, restless leg syndrome, tourette syndrome/tic disorder, back pain, concussion/mild traumatic brain injury (mtbi), cervical dystonia, or epilepsy)
Short description: No doc fall med rsn
HCPCS · United States
Medicare details
The indicators CMS publishes with M1497 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 M1497 sits
- 1M codesMedical services and quality measures
- 2Active code M1497Documentation of falls not performed due to medical reasons (e.g., syncope, vertigo and related disorders, restless leg syndrome, tourette syndrome/tic disorder, back pain, concussion/mild traumatic brain injury (mtbi), cervical dystonia, or epilepsy)
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 M1497 mean?
M1497 is the HCPCS code for “Documentation of falls not performed due to medical reasons (e.g., syncope, vertigo and related disorders, restless leg syndrome, tourette syndrome/tic disorder, back pain, concussion/mild traumatic brain injury (mtbi), cervical dystonia, or epilepsy)” in CMS’s HCPCS Level II October 2026 release.
Does Medicare cover M1497?
CMS lists M1497’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 M1497
All M codesM1491Receiving esrd mcp dialysis services by the provider during the performance periodM1492Patients who did not report a fallM1493Documentation of falls not performed due to medical reasons (e.g., syncope, vertigo and related disorders, restless leg syndrome, tourette syndrome/tic disorder, back pain…M1494Patients that reported a fall since the last visitM1495Patients that reported a fall occurred who had a plan of care for falls documented or patients that did not report a fallM1496Patients that had a fall who did not have a plan of care for falls documented or do not have documentation of being assessed for fallsM1498Diagnostic radiology mips value pathwayM1499Interventional radiology mips value pathwayM1500Neuropsychology mips value pathwayM1501Pathology mips value pathwayM1502Podiatry mips value pathwayM1503Vascular surgery mips value pathway