M1028 Headache Imaging (HCPCS) Reimbursement | OpenPayer

Summary & Overview

HCPCS M1028: Headache Imaging Other Than CT or MRI Documentation

HCPCS Level II code M1028 denotes documentation for patients with a primary headache diagnosis when imaging modalities other than CT or MRI are obtained. The code captures clinical situations in which alternative imaging approaches are used as part of headache assessment and documentation, and it helps payers and providers track utilization of non-CT/non-MRI diagnostic pathways. Nationally, this code matters as part of efforts to align imaging use with clinical appropriateness and to monitor resource use in acute and outpatient settings.

Key payers covered in this publication include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of what M1028 represents, typical sites of service, and the clinical context surrounding non-CT/non-MRI imaging for headache. The publication also summarizes available benchmarks and common billing modifiers, notes on documentation expectations, and policy considerations relevant to payers and providers. If specific supporting datasets, taxonomies, or ICD-10 pairings are needed, the report indicates where data is not available in the input.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareM1028HCPCS Level IIheadachediagnostic imagingemergency departmentoutpatient imagingdocumentationclinical appropriateness

Billing Code Overview

HCPCS Level II code M1028 documents patients with a primary headache diagnosis for whom imaging other than CT or MRI was obtained. The service pertains to clinical documentation of headache evaluation when alternative imaging modalities (for example, plain radiography, nuclear medicine studies, or ultrasound when clinically appropriate) are used instead of computed tomography (CT) or magnetic resonance imaging (MRI).

Service type: Diagnostic imaging documentation related to headache evaluation
Typical site of service: Emergency department, outpatient imaging centers, or hospital outpatient departments where non-CT/non-MRI imaging is performed for headache assessment

Clinical & Coding Specifications

Clinical Context

A 38-year-old female presents to the emergency department with sudden-onset, severe unilateral headache without focal neurologic deficits. The initial clinical evaluation documents a primary headache disorder as the working diagnosis. Because clinical concern exists for a non-CT/MRI process such as suspected subarachnoid hemorrhage with equivocal noncontrast CT or concern for vascular abnormality, the treating team orders vascular imaging other than CT or MRI (for example, diagnostic cerebral angiography or vascular ultrasound) to evaluate intracranial or extracranial blood flow. The typical workflow includes triage and nurse assessment, physician evaluation and documentation of headache history and neurological exam, informed consent for the imaging procedure, performance of the alternative imaging study (e.g., catheter cerebral angiography or transcranial Doppler), interpretation by a qualified physician, and procedural documentation noting indication, technique, findings, and any complications.

Typical site of service: Hospital outpatient department, Emergency department, or Ambulatory surgical center when invasive vascular imaging (catheter angiography) is performed.

Service type: Diagnostic vascular imaging or diagnostic angiographic procedure (non-CT/MRI) performed to evaluate patients with a primary headache diagnosis when CT or MRI are not the imaging modality used.

Coding Specifications

Modifier	Description	When to Use

HCPCS Level II M1050: Oswestry Disability Index Functional Status Measurement

HCPCS-M1059-HOSPICE-OR-PALLIATIVE-CARE-STATUS

HCPCS Level II M1059: Hospice or Palliative Care Status

HCPCS-M1026-HOSPICE-STATUS-ANY-TIME-DURING-PERFORMANCE-PERIOD

HCPCS M1026: Patients in Hospice During Performance Period

HCPCS-M1068-NON-AMBULATORY-ADULT-CARE

HCPCS Level II M1068: Adults Who Are Not Ambulatory

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

HCPCS M1023: Adolescent Depression Remission at Six Months

HCPCS-M1069-FALL-RISK-SCREENING-ASSESSMENT

HCPCS M1069: Patient Screened for Future Fall Risk

HCPCS-M1062-PATIENT-IMMUNOCOMPROMISED

HCPCS M1062: Patient Immunocompromised

HCPCS-M1010-DISCHARGE-EPISODE-OF-CARE-DOCUMENTED

HCPCS Level II M1010: Discharge of Episode of Care Documented

HCPCS-M1005-TB-SCREENING-NOT-PERFORMED-UNINTERPRETED-RESULTS

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

HCPCS-LEVEL-II-M1022-HOSPICE-ENROLLED-PATIENTS

HCPCS Level II M1022: Patients Enrolled in Hospice During Performance Period

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Taxonomy Code	Specialty	Notes
2084P0800X	Interventional Radiology	Commonly performs catheter cerebral angiography and vascular diagnostic studies.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`G44.1`	Vascular headache, not elsewhere classified (migraine)	Primary headache diagnosis often prompting vascular evaluation when atypical features or neurologic change are present.

| G43.909 | Migraine, unspecified, not intractable, without status migrainosus | Common primary headache diagnosis; imaging other than CT/MRI may be performed when vascular etiologies are considered.

| R51 | Headache | General presenting symptom that may lead to vascular imaging when initial evaluation suggests vascular etiology.

| I60.9 | Subarachnoid hemorrhage, unspecified | Serious vascular cause of acute severe headache; diagnostic vascular imaging other than CT/MRI may be used when CT is nondiagnostic or catheter angiography is indicated.

| G44.209 | Tension-type headache, unspecified, not intractable | Primary headache disorder that may be evaluated with vascular studies in atypical presentations.

| G44.89 | Other headache syndromes | Includes secondary or less common headache types where alternative vascular imaging may be appropriate.

| G44.42 | Medication overuse headache | Considered in differential; vascular imaging generally low-yield but sometimes performed in complex cases.

| G44.011 | Cluster headache, unspecified | Trigeminal autonomic cephalalgia that can prompt vascular imaging when atypical features suggest secondary causes.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`36221`	Selective catheterization, cervical or cerebral, arterial, diagnostic, each vessel; initial vessel	Used when performing catheter diagnostic cerebral angiography for vascular evaluation in headache workup; typically first vessel catheterized.

| 36222 | Selective catheterization, cervical or cerebral, arterial, diagnostic, each additional vessel | Billed for each additional intracranial or extracranial vessel catheterized during diagnostic cerebral angiography.

| 70544 | Magnetic resonance angiography, head; without contrast material(s) | Alternative vascular imaging modality; may be ordered when non-CT/MRI vascular imaging is chosen though M1028 denotes imaging other than CT or MRI obtained—this CPT is listed here as a commonly considered alternative in the workflow.

| 93886 | Duplex scan of cerebrovascular arteries, complete bilateral study | Noninvasive vascular ultrasound option used to evaluate extracranial carotid or vertebral arteries in headache evaluation.

| 61624 | Percutaneous transluminal angioplasty of intracranial or vertebral artery, each vessel | Therapeutic interventional code that may follow diagnostic angiography if treatment is indicated; documents subsequent intervention following diagnostic imaging.

| 99285 | Emergency department visit, high severity | Represents the typical high-acuity ED evaluation that leads to ordering advanced vascular imaging for acute severe headache.

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