M1198 Isa not red 3pts /no assess
Also known as: inadequate symptom improvement, symptom control not achieved
Symptom intensity or quality or affect not reduced by 3 or more points from initial assessment or assessment not performed.
In Plain Language
Symptoms did not significantly improve; Minimal symptom management success
Clinical Context
Quality measure denominator tracking palliative care cases with inadequate symptom control or missing symptom reassessment, indicating potential care gap.
RVU Information
CPT M1198 does not have a physician work RVU assigned by CMS. Reimbursement for this code is determined by payer-specific fee schedules.
Billing & Documentation
M-codes cover quality measures and performance reporting. They are used in value-based care programs to track whether specific clinical actions were taken. Documentation must support that the measured action was performed or a valid exclusion applies.
Specialties
Frequently Asked Questions
What is CPT code M1198?
CPT M1198 (Isa not red 3pts /no assess) is a M Codes code. Symptom intensity or quality or affect not reduced by 3 or more points from initial assessment or assessment not performed.
Is M1198 covered by insurance?
M1198 is a temporary HCPCS code. Coverage varies by payer and may change when permanent codes are assigned. Quality measure denominator tracking palliative care cases with inadequate symptom control or missing symptom reassessment, indicating potential care gap.
When is CPT M1198 used?
Quality measure denominator tracking palliative care cases with inadequate symptom control or missing symptom reassessment, indicating potential care gap.
Track This Code in RVU Edge
Log procedures, calculate wRVUs, and benchmark against national data — all in one app.
CPT® is a registered trademark of the American Medical Association. Data sourced from CMS Physician Fee Schedule RVU26A. Descriptions, synonyms, and clinical context are original content by RVU Edge.