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HCPCS Level II M1300: Influenza Immunization Not Administered
HCPCS Level II code M1300 denotes that an influenza vaccine was not administered and the clinician documented the reason. This code captures clinical and operational circumstances—medical contraindication, patient refusal, or vaccine unavailability—that affect immunization delivery. Nationally, accurate use of this code matters for public health surveillance, quality measurement, and claims-level documentation of missed vaccinations during preventive encounters.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of how the code is used in practice, common settings where it appears, and implications for billing and quality reporting. The publication outlines benchmarks where available, explains typical service lines and sites of service, and summarizes the clinical context that justifies documented non-administration. Data gaps are noted where input information is incomplete.
This summary provides actionable clarity on code definition and use across payers, helping administrators, coders, and compliance teams understand when to expect M1300 on claims and what contextual documentation is required for accurate record keeping and reporting.
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Billing Code Overview
HCPCS Level II code M1300 indicates that influenza immunization was not administered with the reason documented by the clinician. Examples of acceptable documentation include patient medical contraindication (such as allergy), patient declined or other patient reasons, and vaccine not available or other system reasons.
Service type: Immunization screening / vaccine administration encounter where immunization was not given.
Typical site of service: Outpatient clinic, primary care office, pharmacy immunization site, or other ambulatory care settings where influenza vaccination would normally be offered.