HCPCS M1004 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | • Screening Procedures • TB Screening |
| Complexity Level | Low |
National average reimbursement for HCPCS M1004 by major payers:
$70.12
$N/A
$49.42
$N/A
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
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HCPCS M1004 vs. Other TB Screening Codes
The HCPCS M1004 code is part of the Screening Procedures services used for TB Screening. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The HCPCS M1004 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| M1003-HCPCS | Low | Tb screening performed and results interpreted within twelve months prior to initiation of first-time biologic and/or immune response modifier therapy |
| M1004-HCPCS | Low | 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-HCPCS | Low | Tb screening not performed or results not interpreted, reason not given |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS M1004. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the M1004 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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