M1054 HCPCS code: Patient had only urgent care visits during the performance period
M1054 is the HCPCS Level II code for patient had only urgent care visits during the performance period. 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 | 2019-01-01 |
| Last action effective | 2019-01-01 |
What changed for M1054
- 2019-01-01: M1054 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 M1054?
M1054 is the HCPCS Level II code for patient had only urgent care visits during the performance period. Short descriptor: "Pt uc in pp".
Does Medicare cover M1054?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Related M10 codes
- M1000 — Pain screened as moderate to severe
- M1001 — Plan of care to address moderate to severe pain documented on or before the date of the second visit with a clinician
- M1002 — Plan of care for moderate to severe pain not documented on or before the date of the second visit with a clinician, reason not given
- M1003 — Tb screening performed and results interpreted within twelve months prior to initiation of first-time biologic and/or immune response modifier therapy
- M1004 — Documentation of medical reason for not screening for tb or interpreting results (i.e., patient positive for tb and documentation of past treatment; patient who has recently completed a course of anti-tb therapy)
- M1005 — Tb screening not performed or results not interpreted, reason not given
- M1006 — Disease activity not assessed, reason not given
- M1007 — >=50% of total number of a patient's outpatient ra encounters assessed
- M1008 — <50% of total number of a patient's outpatient ra encounters assessed
- M1009 — Discharge/discontinuation of the episode of care documented in the medical record
- M1010 — Discharge/discontinuation of the episode of care documented in the medical record
- M1011 — Discharge/discontinuation of the episode of care documented in the medical record
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Next steps
- Run a reimbursement report for a device billed under M1054
- Watch M1054 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for M1054
Sources: CMS HCPCS Level II release October 2026; 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.