M1057 Antiplatelet Therapy Not Used (HCPCS) Reimbursement | OpenPayer

Summary & Overview

HCPCS M1057: Antiplatelet Therapy Not Used, Reason Not Given

HCPCS Level II code M1057 denotes that aspirin or another antiplatelet therapy was not used and no reason was specified. This documentation code matters nationally because antiplatelet use is a common element of cardiovascular and perioperative care; recording the absence of therapy has implications for clinical records, quality measurement, and claims adjudication. The code helps payers and providers track instances where expected therapy was omitted without a documented rationale.

Key payers covered in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the code’s clinical context, how it is typically used in inpatient and outpatient settings, and what documentation this code represents. The publication summarizes common billing modifiers associated with medication and procedure reporting, notes that specific related taxonomies and ICD-10 pairings are not provided in the input, and highlights areas where payers commonly review such claims for medical necessity and coding completeness.

The report provides national-level benchmarks and policy context where available, explains typical service lines and sites of service for M1057, and outlines gaps in the input data where additional payer- or facility-specific guidance may be required. Data not available in the input is identified transparently.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareM1057HCPCS Level IIantiplateletaspirinmedication-administrationquality-measurementclinical-documentationinpatient-outpatient

Billing Code Overview

HCPCS Level II code M1057 indicates aspirin or another antiplatelet therapy not used, reason not given. This code documents that an antiplatelet agent (for example, aspirin) was not administered or prescribed, without a specified reason recorded.

Service type: Medication administration / pharmacologic management (antiplatelet therapy not given)

Typical site of service: Inpatient or outpatient clinical settings where antiplatelet therapy would be considered, such as hospitals, emergency departments, ambulatory clinics, or procedural units.

Clinical & Coding Specifications

Clinical Context

A 72-year-old male with a history of recent ischemic stroke is evaluated on admission to a short-stay observation unit. The care team documents that antiplatelet therapy such as aspirin is not administered during the inpatient/observation stay and the reason for omission is not recorded in the medical record. Typical workflow includes initial neurologic assessment, medication reconciliation, documentation of secondary stroke prevention plan, and nursing medication administration. A clinician or coder reviewing the chart may assign HCPCS Level II code M1057 when an antiplatelet agent was not used and no documented reason explains the omission. Documentation review often includes reconciliation of home medications, review of contraindications (active bleeding, recent surgery), and cross-checking orders and MAR (medication administration record) to confirm absence of antiplatelet therapy.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when additional work or complexity related to medication management or documentation significantly exceeds typical service for the encounter.
`23`

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

HCPCS-LEVEL-II-M1036-OUD-PHARMACOTHERAPY-CONTINUITY-180-DAYS

HCPCS Level II M1036: Adults Without 180 Days Continuous OUD Pharmacotherapy

HCPCS-M1060-PATIENT-DIED-PRIOR-TO-PERFORMANCE-PERIOD

HCPCS M1060: Patient Died Prior to End of Performance Period

HCPCS-M1033-PHARMACOTHERAPY-INITIATION-OPIOID-USE-DISORDER

HCPCS Level II M1033: Pharmacotherapy Initiation for Opioid Use Disorder

HCPCS-M1020-ADOLESCENT-DEPRESSION-12-MONTH-NOT-IN-REMISSION

HCPCS Level II M1020: Adolescent Depression 12-Month Non-Remission

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

HCPCS M1023: Adolescent Depression Remission at Six Months

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

HCPCS Level II M1010: Discharge of Episode of Care Documented

HCPCS-M1004-DOCUMENTATION-REASON-NOT-SCREENING-TB

HCPCS M1004: Documentation of Medical Reason for Not Screening for TB

HCPCS-M1016-FEMALE-INFERTILITY-ASSESSMENT

HCPCS M1016: Female Infertility Assessment and Management

HCPCS-M1061-PATIENT-PREGNANCY-ASSESSMENT-DOCUMENTATION

HCPCS Level II M1061: Patient Pregnancy

Showing 1–10 of 67

Taxonomy Code	Specialty	Notes
`207RC0000X`	Cardiovascular Disease (Cardiology)	Cardiologists commonly manage antiplatelet therapy for ischemic heart disease and stroke prevention.
`208000000X`	General Surgery	Surgeons make perioperative antiplatelet decisions for operative patients where omission may be documented.
`363A00000X`	Nurse Practitioner	Nurse practitioners frequently perform medication reconciliation and document reasons for medication omissions.
`207L00000X`	Interventional Cardiology	Interventional cardiologists manage antiplatelet regimens around procedures like PCI where omission may be recorded.
`207Q00000X`	Vascular Surgery	Vascular surgeons manage antiplatelet therapy for peripheral and vascular procedures and document omissions.

ICD-10 Code	Description	Clinical Relevance
Data not available in the input.	Data not available in the input.	Data not available in the input.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99221`	Initial hospital care, typically 30 minutes at bedside	Admission evaluation that may include medication reconciliation and documentation of why aspirin was not given.
`99231`	Subsequent hospital care, typically 15 minutes at bedside	Follow-up inpatient visits where omission of antiplatelet therapy might be reassessed and documented.
`99495`	Transitional care management, moderate complexity	Post-discharge care coordination that may address changes in antiplatelet therapy or document prior omissions.
`96372`	Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular	Used if an alternative antiplatelet or anticoagulant was administered by injection instead of oral aspirin; documents actual medication administration versus omission.
`93571`	Coronary thrombolysis via intracoronary infusion (select examples)	Procedure codes for interventional cardiac procedures that commonly involve peri-procedural antiplatelet management; omission may be noted in peri-procedural documentation.

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