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See a sample rate comparisonHCPCS M1057 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.
Aspirin or another antiplatelet therapy not used, reason not given
| Key Fact | Detail |
|---|---|
| Service Type | Screening Procedures Anticoagulation Management |
| Complexity Level | Low |
National average reimbursement for HCPCS M1057 by major payers:
$70.12
$N/A
$49.42
$0.00
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HCPCS M1057
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See a sample payer proposalHCPCS M1057 vs. Other Anticoagulation Management Codes
The HCPCS M1057 code is part of the Screening Procedures services used for Anticoagulation Management. 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 M1057 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 |
|---|---|---|
| M1056-HCPCS | Low | Prescribed anticoagulant medication during the performance period, history of gi bleeding, history of intracranial bleeding, bleeding disorder and specific provider documented reasons: allergy to aspirin or anti-platelets, use of non-steroidal anti-inflammatory agents, drug-drug interaction, uncontrolled hypertension > 180/110 mmhg or gastroesophageal reflux disease |
| M1057-HCPCS | Low | Aspirin or another antiplatelet therapy not used, reason not given |
| M1058-HCPCS | Low | Patient was a permanent nursing home resident at any time during the performance period |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS M1057. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the M1057 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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