Summary & Overview
HCPCS M1189: Kidney Health Evaluation with eGFR and UACR
HCPCS Level II code M1189 represents documentation of a kidney health evaluation consisting of an estimated glomerular filtration rate (eGFR) and a urine albumin-creatinine ratio (UACR). This bundled documentation code signals attention to both renal filtration and proteinuria—core elements for detecting chronic kidney disease (CKD) risk and monitoring disease progression. Nationally, consistent capture of these assessments supports quality measurement, risk stratification, and early intervention pathways across outpatient settings.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication outlines coverage and billing patterns relevant to these major payers, where available, and highlights how the code aligns with clinical priorities for CKD screening and surveillance.
Readers will find a concise overview of the clinical context for the evaluation, typical sites of service, and the implications for documentation and claims processing. The report also summarizes benchmarks and policy considerations where available, including common modifiers used in practice. Where specific payer or coding details were not provided in the input, the text indicates that data is not available. The aim is to give clinicians, coders, and policy stakeholders a clear, national-level briefing on HCPCS Level II code M1189 and its role in kidney health assessment workflows.
Billing Code Overview
HCPCS Level II code M1189 documents a kidney health evaluation based on laboratory measures: an estimated glomerular filtration rate (eGFR) and a urine albumin-creatinine ratio (UACR). The code reflects the performance and documentation of these two tests together as a clinical assessment of renal function and albuminuria.
Service Type: Laboratory-based kidney function assessment
Typical Site of Service: Outpatient clinic, physician office, or outpatient laboratory
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 58-year-old patient with long-standing type 2 diabetes and hypertension presents to an outpatient primary care clinic for annual chronic disease management. The clinician orders a kidney health evaluation consisting of a serum creatinine to calculate an estimated glomerular filtration rate (eGFR) and a urine albumin-creatinine ratio (uACR) to assess kidney function and detect albuminuria. The clinical workflow: the patient checks in at the clinic, nursing staff obtain vitals and a random spot urine specimen; a blood sample is drawn for serum creatinine. The laboratory performs serum chemistry and urine albumin and creatinine assays and returns results to the electronic health record. The ordering clinician documents the eGFR value and uACR interpretation in the chart, including the clinical interpretation (normal, decreased eGFR, microalbuminuria, macroalbuminuria) and any plan for follow-up or nephrology referral. The service typically occurs in an outpatient clinic or ambulatory laboratory setting and is billed as a kidney health evaluation service when documentation of both eGFR and uACR is present.
Coding Specifications
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