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See a sample rate comparisonHCPCS M1043 Fee Schedule
HCPCS M1043 is classified under Screening Procedures, in the Functional STATUS Measurement subgroup.
Functional status was not measured by the oswestry disability index (odi version 2.1a) at one year (9 to 15 months) postoperatively
| Key Fact | Detail |
|---|---|
| Service Type | Screening Procedures Functional STATUS Measurement |
| Complexity Level | Low |
National average reimbursement for HCPCS M1043 by major payers:
$71.42
BCBS / Anthem
$N/A
UnitedHealthcare
$49.42
Aetna
$N/A
Cigna
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HCPCS M1043
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Payer Contract Negotiation
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See a sample payer proposalHCPCS M1043 vs. Other Functional STATUS Measurement Codes
The table lists codes related to M1043. Select one to see its fee schedule.
| Code | Complexity | Description |
|---|---|---|
| M1041-HCPCS | Low | Patient had cancer, acute fracture or infection related to the lumbar spine or patient had neuromuscular, idiopathic or congenital lumbar scoliosis |
| M1043-HCPCS | Low | Functional status was not measured by the oswestry disability index (odi version 2.1a) at one year (9 to 15 months) postoperatively |
| M1045-HCPCS | Low | Functional status measured by the oxford knee score (oks) at one year (9 to 15 months) postoperatively was greater than or equal to 37 or knee injury and osteoarthritis outcome score joint replacement (koos, jr.) was greater than or equal to 71 |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS M1043. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the M1043 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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