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See a sample rate comparisonHCPCS M1164 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.
Patients with dementia any time during the patient's history through the end of the measurement period
| Key Fact | Detail |
|---|---|
| Service Type | Other Services |
| Complexity Level | Low |
National average reimbursement for HCPCS M1164 by major payers:
$70.52
$N/A
$49.42
$N/A
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HCPCS M1164
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Payer Contract Negotiation
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See a sample payer proposalHCPCS M1164 vs. Other Other Services Codes
The HCPCS M1164 code is part of the Other Services 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 M1164 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 |
|---|---|---|
| M1163-HCPCS | Low | Patient had anaphylaxis due to the hpv vaccine any time on or before the patient's 13th birthday |
| M1164-HCPCS | Low | Patients with dementia any time during the patient's history through the end of the measurement period |
| M1165-HCPCS | Low | Patients who use hospice services any time during the measurement period |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS M1164. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the M1164 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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