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See a sample rate comparisonHCPCS M1006 Fee Schedule
Last Verified: September 2026
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.
Disease activity not assessed, reason not given
| Key Fact | Detail |
|---|---|
| Service Type | Screening Procedures Evaluation AND Assessment |
| Complexity Level | Low |
National average reimbursement for HCPCS M1006 by major payers:
$70.12
$N/A
$49.42
$0.00
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HCPCS M1006
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See a sample payer proposalHCPCS M1006 vs. Other Evaluation AND Assessment Codes
The HCPCS M1006 code is part of the Screening Procedures services used for Evaluation AND Assessment. 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 M1006 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 |
|---|---|---|
| M1005-HCPCS | Low | Tb screening not performed or results not interpreted, reason not given |
| M1006-HCPCS | Low | Disease activity not assessed, reason not given |
| M1007-HCPCS | Low | >=50% of total number of a patient's outpatient ra encounters assessed |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS M1006. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the M1006 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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