M1423 HCPCS code: Optimal care for patients with urologic conditions mips value pathway
M1423 is the HCPCS Level II code for optimal care for patients with urologic 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 | 2025-01-01 |
| Last action effective | 2025-01-01 |
What changed for M1423
- 2025-01-01: M1423 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 M1423?
M1423 is the HCPCS Level II code for optimal care for patients with urologic conditions mips value pathway. Short descriptor: "Opt care urologic cnd mvp".
Does Medicare cover M1423?
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 M1423
- Watch M1423 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for M1423
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.