M1304 No pneum vax administration 19+
Also known as: pneumococcal vaccine not given, no pneumonia vaccine, pneumococcal vaccination missed
Patient age 19 and older did not receive pneumococcal vaccination. Documents patients who are due for pneumococcal vaccine but did not receive it.
In Plain Language
pneumonia vaccine not given; pneumococcal shot not received
Clinical Context
Quality measure documenting gaps in pneumococcal vaccination where eligible patients (especially those 65+ or with chronic conditions) did not receive appropriate vaccine.
RVU Information
CPT M1304 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 M1304?
CPT M1304 (No pneum vax administration 19+) is a M Codes code. Patient age 19 and older did not receive pneumococcal vaccination. Documents patients who are due for pneumococcal vaccine but did not receive it.
Is M1304 covered by insurance?
M1304 is a temporary HCPCS code. Coverage varies by payer and may change when permanent codes are assigned. Quality measure documenting gaps in pneumococcal vaccination where eligible patients (especially those 65+ or with chronic conditions) did not receive appropriate vaccine.
When is CPT M1304 used?
Quality measure documenting gaps in pneumococcal vaccination where eligible patients (especially those 65+ or with chronic conditions) did not receive appropriate vaccine.
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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.