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See a sample rate comparisonHCPCS M1197 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.
Itch severity assessment score is reduced by 3 or more points from the initial (index) assessment score to the follow-up visit score
| Key Fact | Detail |
|---|---|
| Service Type | Other Services |
| Complexity Level | Low |
National average reimbursement for HCPCS M1197 by major payers:
$70.52
$N/A
$49.42
$0.00
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HCPCS M1197
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See a sample payer proposalHCPCS M1197 vs. Other Other Services Codes
The HCPCS M1197 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 M1197 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 |
|---|---|---|
| M1196-HCPCS | Low | Initial (index visit) numeric rating scale (nrs), visual rating scale (vrs), or itchyquant assessment score of greater than or equal to 4 |
| M1197-HCPCS | Low | Itch severity assessment score is reduced by 3 or more points from the initial (index) assessment score to the follow-up visit score |
| M1198-HCPCS | Low | Itch severity assessment score was not reduced by at least 3 points from initial (index) score to the follow-up visit score or assessment was not completed during the follow-up encounter |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS M1197. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the M1197 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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