Summary & Overview
HCPCS M1150: Left Ventricular Ejection Fraction ≤40% or Moderately/Severely Depressed LV Function
HCPCS Level II code M1150 identifies documentation that a patient has a current or prior left ventricular ejection fraction (LVEF) ≤ 40% or moderately to severely depressed left ventricular systolic function. Nationally, this clinical indicator is important for care planning, risk stratification, and eligibility for certain heart-failure–related programs and therapies. The code provides a standardized way to flag significant systolic dysfunction in administrative records, supporting population health management and quality measurement.
Key payers covered in this briefing include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the code, the typical service types and sites where it is recorded, and notes on billing and documentation implications. The publication outlines benchmark and policy topics relevant to payers and providers, including coding prevalence, claims handling considerations, and intersections with heart failure care pathways. Data limitations are noted where input fields were not provided.
This summary is intended for health plan analysts, provider billing teams, and clinical leaders seeking a clear, national-level overview of HCPCS Level II code M1150 and its role in documenting significant left ventricular systolic dysfunction.
Billing Code Overview
HCPCS Level II code M1150 documents a current or prior left ventricular ejection fraction (LVEF) less than or equal to 40% or clinical documentation of moderately or severely depressed left ventricular systolic function. This code captures a cardiac functional status measure often used in clinical records and administrative claims to indicate significant systolic dysfunction.
Service type: Cardiology diagnostic/clinical status assessment
Typical site of service: Inpatient or outpatient cardiology settings, including hospitals, cardiology clinics, and home health encounters where cardiac function is evaluated or documented.
Clinical & Coding Specifications
Clinical Context
A 68-year-old male with ischemic cardiomyopathy and prior anterior myocardial infarction presents for routine cardiology follow-up. The patient has a history of heart failure with reduced ejection fraction and is being evaluated for medication optimization and device candidacy. The clinical workflow begins with review of prior imaging and echocardiogram reports documenting a left ventricular ejection fraction at or below 40% or wording indicating moderately to severely depressed left ventricular systolic function. The cardiologist documents current or prior reduced LVEF in the medical record, correlates the finding with symptoms (dyspnea on exertion, orthopnea), vital signs, and laboratory tests (BNP), and determines whether additional testing (repeat transthoracic echocardiography, stress testing, cardiac MRI) or interventions (guideline-directed medical therapy adjustment, referral for implantable cardioverter-defibrillator evaluation) are indicated. The documentation must clearly state the current or prior LVEF measurement or the qualitative assessment of systolic function (moderate or severe depression) to support billing of M1150 when reporting services that require confirmation of reduced left ventricular function, such as durable medical equipment coverage, care planning, or device candidacy evaluation. Typical sites of service include outpatient cardiology clinics, inpatient cardiology consults, heart failure clinics, and ambulatory imaging centers.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 |