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See a sample rate comparisonHCPCS M1142 Fee Schedule
Last Verified: October 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.
Emergent cases
| Key Fact | Detail |
|---|---|
| Service Type | Episode of Care |
| Complexity Level | Low |
National average reimbursement for HCPCS M1142 by major payers:
$80.22
$N/A
$49.42
$N/A
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HCPCS M1142
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Payer Contract Negotiation
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See a sample payer proposalHCPCS M1142 vs. Other Episode of Care Codes
The HCPCS M1142 code is part of the Episode of Care services . 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 M1142 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 |
|---|---|---|
| M1141-HCPCS | Low | Functional status was not measured by the oxford knee score (oks) or the knee injury and osteoarthritis outcome score joint replacement (koos, jr.) at one year (9 to 15 months) postoperatively |
| M1142-HCPCS | Low | Emergent cases |
| M1143-HCPCS | Low | Initiated episode of rehabilitation therapy, medical, or chiropractic care for neck impairment |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS M1142. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the M1142 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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