M0004 HCPCS code: Quality care for patients with neurological conditions mips value pathway
M0004 is the HCPCS Level II code for quality care for patients with neurological conditions mips value pathway. Its Medicare coverage code is C (Carrier judgment): Coverage is decided by the Medicare contractor (MAC) case by case.
Code details
| Field | Value |
|---|---|
| Section | M codes — Medical services and quality measures |
| Coverage code | C — Carrier judgment |
| Pricing indicator | 00 — Not separately priced by Medicare |
| BETOS category | Z2 |
| Added | 2023-01-01 |
| Last action effective | 2025-01-01 |
What changed for M0004
- 2023-01-01: M0004 added to HCPCS Level II
- Next scheduled CMS quarterly update (HCPCS and DMEPOS fee schedule): 2027-01-01
Frequently asked questions
What is HCPCS code M0004?
M0004 is the HCPCS Level II code for quality care for patients with neurological conditions mips value pathway. Short descriptor: "Qual care neurologic cnd mvp".
Does Medicare cover M0004?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Related M00 codes
- M0001 — Advancing cancer care mips value pathways
- M0002 — Optimal care for kidney health mips value pathways
- M0003 — Optimal care for patients with episodic neurological conditions mips value pathways
- M0005 — Value in primary care mips value pathway
- M0010 — Enhancing oncology model (eom) monthly enhanced oncology services (meos) payment for eom enhanced services
- M0064 — Brief office visit for the sole purpose of monitoring or changing drug prescriptions used in the treatment of mental psychoneurotic and personality disorders
- M0075 — Cellular therapy
- M0076 — Prolotherapy
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Next steps
- Run a reimbursement report for a device billed under M0004
- Watch M0004 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for M0004
Sources: CMS HCPCS Level II release October 2025; CMS DMEPOS fee schedule; CMS NCCI MUE tables; CMS Medicare utilization (physician and DME supplier files); CMS Medicare Coverage Database articles. Fees are Medicare allowables, not commercial rates. Not billing or legal advice.