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See a sample rate comparisonHCPCS M1036 Fee Schedule
HCPCS M1036 is classified under Screening Procedures, in the Pharmacotherapy for OUD subgroup.
Adults who have not had at least 180 days of continuous pharmacotherapy with a medication prescribed for oud without a gap of more than seven days
| Key Fact | Detail |
|---|---|
| Service Type | Screening Procedures Pharmacotherapy for OUD |
| Complexity Level | Low |
National average reimbursement for HCPCS M1036 by major payers:
$70.12
BCBS / Anthem
$N/A
UnitedHealthcare
$49.42
Aetna
$0.00
Cigna
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HCPCS M1036
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Payer Contract Negotiation
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See a sample payer proposalHCPCS M1036 vs. Other Pharmacotherapy for OUD Codes
The table lists codes related to M1036. Select one to see its fee schedule.
| Code | Complexity | Description |
|---|---|---|
| M1035-HCPCS | Low | Adults who are deliberately phased out of medication assisted treatment (mat) prior to 180 days of continuous treatment |
| M1036-HCPCS | Low | Adults who have not had at least 180 days of continuous pharmacotherapy with a medication prescribed for oud without a gap of more than seven days |
| M1037-HCPCS | Low | Patients with a diagnosis of lumbar spine region cancer at the time of the procedure |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS M1036. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the M1036 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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