M1005 TB Screening — HCPCS Reimbursement & Policy | OpenPayer

Summary & Overview

HCPCS Level II M1005: Tb Screening Not Performed or Results Not Interpreted

HCPCS Level II code M1005 indicates that a tuberculosis (Tb) screening was not performed or that screening results were not interpreted, without a documented reason. Nationally, accurate documentation of Tb screening status is important for infection control, pre-procedure clearance, occupational health, and public health reporting. Use of a specific administrative code such as M1005 helps standardize records where screening did not occur or results remain uninterpreted.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the code’s clinical context, typical sites of service, and how the code is used in administrative and clinical documentation. The publication also provides benchmarks where available, common billing considerations, and any relevant policy or coverage notes that affect how payers treat documentation of missing or uninterpreted Tb screening.

This summary is intended for national audiences including billing professionals, compliance officers, and clinical administrators seeking clarity on the purpose of M1005, its role in documentation workflows, and the payer landscape that commonly addresses Tb screening documentation.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareM1005HCPCS Level IItuberculosis screeningTb documentationoutpatientclinical documentationinfection controladministrative code

Billing Code Overview

HCPCS Level II code M1005 denotes Tb screening not performed or results not interpreted, reason not given. The service type is tuberculosis (Tb) screening documentation/administrative entry indicating no screening or uninterpreted results. The typical site of service for this code is outpatient ambulatory settings or clinical documentation where Tb screening would normally be recorded, including primary care clinics, public health clinics, and pre-procedure or pre-employment screening encounters.

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A patient presents to a primary care clinic for routine occupational or pre-employment screening that includes tuberculosis screening. The clinician documents that a tuberculin skin test (TST) or interferon-gamma release assay (IGRA) was ordered but the test was not performed or the results were not available or could not be interpreted; no reason is recorded in the chart. Typical workflow: patient check-in and intake, medical assistant initiates TB screening order, specimen collection or TST placement is scheduled; if the patient fails to return for TST reading, the lab specimen is lost/unprocessed, or the IGRA sample is hemolyzed or not processed, the clinician documents the intended screening but cannot document a completed, interpretable result. The visit is coded with M1005 when the TB screening was not performed or results were not interpreted and no reason is given. Typical site of service is outpatient primary care, occupational health clinics, urgent care, or community health centers. Typical patient scenarios include pre-employment clearance, school or sports clearance, routine public health screening for high-risk individuals, or follow-up visits where ordered testing was not completed.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when services provided require substantially greater effort or complexity than typical for the visit where is reported alongside a billed service.

Related Codes

HCPCS-M1068-NON-AMBULATORY-ADULT-CARE

HCPCS Level II M1068: Adults Who Are Not Ambulatory

HCPCS-M1027-HEAD-IMAGING-CT-MRI-OBTAINED

HCPCS M1027: Head Imaging (CT or MRI) Obtained

HCPCS-M1023-ADOLESCENT-DEPRESSION-REMISSION-6-MONTHS

HCPCS M1023: Adolescent Depression Remission at Six Months

HCPCS-M1015-DISCHARGE-EPISODE-OF-CARE

HCPCS Level II M1015: Discharge/Discontinuation of Episode of Care

HCPCS-M1003-TB-SCREENING-BEFORE-BIOLOGIC-INITIATION

HCPCS Level II M1003: Tb Screening Prior to First-Time Biologic Therapy

HCPCS-M1039-LUMBAR-SPINE-INFECTION-PROCEDURE

HCPCS Level II M1039: Lumbar Spine Region Infection at Procedure Time

HCPCS-M1063-HIGH-DOSE-IMMUNOSUPPRESSIVE-THERAPY

HCPCS Level II M1063: High-Dose Immunosuppressive Therapy

HCPCS-M1035-PHASED-OUT-MAT-BEFORE-180-DAYS-CONTINUOUS-TREATMENT

HCPCS Level II M1035: Adults Phased Out of MAT Before 180 Days

HCPCS-M1067-HOSPICE-SERVICES-MEASUREMENT-PERIOD

HCPCS Level II M1067: Hospice Services During Measurement Period

HCPCS-M1069-FALL-RISK-SCREENING-ASSESSMENT

HCPCS M1069: Patient Screened for Future Fall Risk

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M1005

Taxonomy Code	Specialty	Notes
`207Q00000X`	Family Medicine	Primary care clinicians ordering or interpreting TB screening.
`207R00000X`	Internal Medicine	Adult primary care clinicians managing screening and follow-up.
`208000000X`	Pediatric Medicine	Providers ordering TB screening in pediatric populations.
`163W00000X`	Occupational Medicine	Occupational health clinicians performing pre-employment TB screening.
`363L00000X`	Infectious Disease	Specialists consulted for latent TB evaluation when screening is incomplete or indeterminate.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`Z11.1`	Encounter for screening for respiratory tuberculosis	Standard screening indication prompting TST or IGRA; if testing not completed, `M1005` is relevant.
`Z20.0`	Contact with and (suspected) exposure to tuberculosis	TB exposure evaluation often prompts testing; `M1005` used when exposure screening is ordered but not completed or interpretable.
`R76.11`	Nonspecific reaction to tuberculosis skin test without mention of active infection	Used when skin test results are documented; if test was not performed/interpretable, `M1005` documents that absence.
`Z02.89`	Encounter for other administrative examinations (e.g., pre-employment)	Pre-employment clearance commonly includes TB screening; `M1005` is used when screening was not performed or results not interpretable.
`Z71.89`	Other specified counseling (includes health screening counseling)	Counseling or education visits where testing is ordered but not completed may accompany `M1005`.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`86580`	Skin test; tuberculosis, intradermal (e.g., Mantoux)	Commonly used when a TST is placed; `M1005` may be reported if the test was not read or not performed.
`86480`	Interferon-gamma release assay (e.g., QuantiFERON)	Laboratory-based TB screening test; if the IGRA sample is not processed or results are uninterpretable, `M1005` applies.
`99000`	Handling and/or conveyance of specimen for transfer from physician to laboratory	Billed in workflows involving specimen transport; relevant when specimen transport issues lead to no interpretable TB result.
`99213`	Office or other outpatient visit for the evaluation and management of an established patient, typically 15 minutes	Typical visit code for primary care encounters where TB testing is ordered but not completed; `M1005` documents the missing test.
`99406`	Smoking and tobacco use cessation counseling visit, intermediate	May be contemporaneously billed when counseling occurs alongside TB screening processes in high-risk populations.