Rate Benchmarking
Compare your rates with similar providers.
Select a published rate, define comparable providers, and see where that rate falls in your market.
See a sample rate comparisonHCPCS M1051 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.
Patient had cancer, acute fracture or infection related to the lumbar spine or patient had neuromuscular, idiopathic or congenital lumbar scoliosis
| Key Fact | Detail |
|---|---|
| Service Type | Screening Procedures Lumbar Spine Conditions |
| Complexity Level | Low |
National average reimbursement for HCPCS M1051 by major payers:
$71.60
$N/A
$49.42
$N/A
Compare published rates across providers.
Choose a payer to see a sample of rates for HCPCS M1051.
HCPCS M1051
No sample rates available for this payer and code. Search provider rates to explore coverage.
Get a free rate benchmark for your specialty.
Choose your state and specialty to build a report from payer-published rates.
Use market rates to prepare your payer proposal.
Payer Contract Negotiation
Draft a fee schedule renegotiation letter.
Use your fee schedule and market benchmarks to set target rates and draft a letter for your payer.
See a sample payer proposalHCPCS M1051 vs. Other Lumbar Spine Conditions Codes
The HCPCS M1051 code is part of the Screening Procedures services used for Lumbar Spine Conditions. 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 M1051 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 |
|---|---|---|
| M1049-HCPCS | Low | Functional status was not measured by the oswestry disability index (odi version 2.1a) at three months (6 - 20 weeks) postoperatively |
| M1051-HCPCS | Low | Patient had cancer, acute fracture or infection related to the lumbar spine or patient had neuromuscular, idiopathic or congenital lumbar scoliosis |
| M1052-HCPCS | Low | Leg pain was not measured by the visual analog scale (vas) or numeric pain scale at one year (9 to 15 months) postoperatively |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS M1051. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the M1051 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.
FREE SAMPLE MARKET COMPARISON
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like HCPCS M1051) and we'll show you how you compare in 15 minutes or less.