Summary & Overview
HCPCS Level II M1055: Aspirin or Other Antiplatelet Therapy Used
HCPCS Level II code M1055 designates the use of aspirin or another antiplatelet therapy. This code documents that an antiplatelet agent was administered or provided as part of clinical care, a key element in managing thrombotic risk and secondary prevention of cardiovascular events. Nationally, accurate capture of antiplatelet therapy supports quality measurement, continuity of care, and appropriate billing for medication-related services.
Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of what M1055 represents, typical sites of service where it is used, and which payers commonly adjudicate these claims. The publication also summarizes benchmarks and billing considerations, relevant clinical context for antiplatelet use, and any notable policy or coverage updates that affect documentation and claim submission.
This overview is intended for billing professionals, clinical coders, and health policy analysts who need a national perspective on the role of M1055 in documenting antiplatelet therapy across care settings. Data not available in the input is noted where applicable.
Billing Code Overview
HCPCS Level II code M1055 indicates aspirin or another antiplatelet therapy used. The service represented is administration or provision of antiplatelet medication for patients who require platelet inhibition as part of treatment or secondary prevention.
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Service type: Medication administration / pharmacologic therapy
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Typical site of service: Ambulatory clinic, hospital inpatient, emergency department, or other clinical settings where antiplatelet therapy is administered
Clinical & Coding Specifications
Clinical Context
A typical patient is a 68-year-old with a history of coronary artery disease who presents to the outpatient cardiology clinic after percutaneous coronary intervention with stent placement. The clinician documents initiation or continuation of antiplatelet therapy, commonly aspirin or another P2Y12 inhibitor, as part of secondary prevention. Service is recorded when antiplatelet therapy is used and monitored in settings such as hospital inpatient cardiology services, outpatient cardiology clinics, ambulatory surgery centers for procedures requiring antiplatelet management, and emergency departments evaluating chest pain or post-procedure care. Clinical workflow: medication reconciliation and indication assessment; counseling on dosing, duration, and bleeding risks; documentation of therapy start/continuation; coordination with procedural teams if antiplatelet therapy affects peri-procedural management; and follow-up monitoring for efficacy and adverse effects.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when additional work, time, or complexity is documented beyond typical expectations for antiplatelet therapy management (e.g., complex counseling or coordination across multiple teams). |
23 |