M1414 HCPCS code: Documentation of medical reason(s) for not performing the pd-l1 biomarker expression test prior to initiation of first-line immune checkpoint inhibitor therapy (e.g., patient is in an urgent or emergent situation where delay of treatment would jeopardize the patient's health status; other medical reasons/contraindication)
M1414 is the HCPCS Level II code for documentation of medical reason(s) for not performing the pd-l1 biomarker expression test prior to initiation of first-line immune checkpoint inhibitor therapy (e.g., patient is in an urgent or emergent situation where delay of treatment would jeopardize the patient's health status; other medical reasons/contraindication). 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 | 2025-01-01 |
| Last action effective | 2025-01-01 |
What changed for M1414
- 2025-01-01: M1414 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 M1414?
M1414 is the HCPCS Level II code for documentation of medical reason(s) for not performing the pd-l1 biomarker expression test prior to initiation of first-line immune checkpoint inhibitor therapy (e.g., patient is in an urgent or emergent situation where delay of treatment would jeopardize the patient's health status; other medical reasons/contraindication). Short descriptor: "Med rsn no pdl1 bef 1st ther".
Does Medicare cover M1414?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Related M14 codes
- M1400 — Patients who died during the follow-up period
- M1401 — Stages i-iii breast cancer
- M1402 — Patients receiving an initial chemotherapy regimen with a defined duration with the eligible clinician or group
- M1403 — Patients with baseline and follow-up promis surveys documented in the medical record
- M1404 — Patients on a therapeutic clinical trial
- M1405 — Patients with recurrence/disease progression
- M1406 — Patients who leave the practice during the follow-up period
- M1407 — Patients who died during the follow-up period
- M1408 — Patients who have germline brca testing completed before diagnosis of epithelial ovarian, fallopian tube, or primary peritoneal cancer
- M1409 — Patients who received germline testing for brca1 and brca2 or genetic counseling completed within 6 months of diagnosis
- M1410 — Patients who did not have germline testing for brca1 and brca2 or genetic counseling completed within 6 months of diagnosis
- M1411 — Currently on first-line immune checkpoint inhibitors without chemotherapy
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Next steps
- Run a reimbursement report for a device billed under M1414
- Watch M1414 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for M1414
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.