Summary & Overview

HCPCS M1213: Spirometry Assessment, No Prior Confirmed Obstruction

HCPCS Level II code M1213 denotes a spirometry assessment documenting that there is no prior record of confirmed airflow obstruction (FEV1/FVC < 70%) and that the current spirometry result is non-obstructive (>= 70%). This code is used in outpatient and ambulatory diagnostic settings to record clinical assessments of lung function that may influence diagnostic pathways, therapy selection, and follow-up planning. Nationally, standardized reporting of spirometry results supports care continuity and accurate classification of obstructive versus non-obstructive respiratory conditions.

Key payers referenced in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for use of M1213, common billing modifiers, and the typical service setting. The publication supplies benchmarks where available, summarizes relevant policy or documentation expectations tied to spirometry reporting, and outlines how the code is positioned relative to related pulmonary function services. Data limitations are noted where input information is not provided. The content is intended for national audiences including billing professionals, clinicians, and compliance officers who need a clear summary of clinical meaning, billing context, and payer considerations for HCPCS Level II code M1213.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareM1213HCPCS Level IIspirometrypulmonary functionambulatory carelung function assessmentFEV1/FVCdiagnostic testing

Billing Code Overview

HCPCS Level II code M1213 indicates a spirometry assessment where there is no prior spirometry evidence of confirmed airflow obstruction (FEV1/FVC < 70%) and the current spirometry result is >= 70%. This code reflects evaluation of lung function to document absence of previously confirmed obstructive physiology and a present non-obstructive result.

Service type: Pulmonary function assessment (spirometry interpretation and documentation)
Typical site of service: Outpatient clinic or ambulatory diagnostic testing facility

Clinical & Coding Specifications

Clinical Context

A 62-year-old patient with a long history of tobacco use and chronic cough presents to the outpatient pulmonary clinic for reassessment of suspected chronic obstructive pulmonary disease (COPD). The medical record contains no prior spirometry demonstrating airflow obstruction (defined as FEV1/FVC < 70%). Current office spirometry is performed and shows an FEV1/FVC ratio ≥ 70%, inconsistent with obstructive physiology. The visit documents symptoms, smoking history, medication use, and decision-making regarding diagnostic uncertainty. The clinical workflow includes pre-test assessment, performance of spirometry by trained staff, interpretation by the ordering clinician, and documentation that no prior confirmatory spirometry exists and current spirometry does not confirm obstruction. This supports use of billing code M1213 to denote "No history of spirometry results with confirmed airflow obstruction (FEV1/FVC < 70%) and present spirometry is >= 70%" in administrative reporting for services related to spirometric reassessment and diagnostic clarification.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when additional documented work beyond typical is required (e.g., extended diagnostic evaluation or complex interpretation).
`23`	Unusual anesthesia	Use if unexpected general anesthesia is required for a procedure performed in conjunction with testing (rare for spirometry).
`52`	Reduced services	Use when spirometry is attempted but not completed to full protocol and service is reduced.
`53`	Discontinued procedure	Use when testing is started but discontinued due to patient intolerance or safety concerns.
`54`	Surgical care only	Generally not applicable; use when postoperative care only is billed by a different provider.
`55`	Postoperative management only	Use when postoperative care is billed separately (rare for spirometry context).
`56`	Preoperative management only	Use if only preoperative assessment is billed by one provider and spirometry by another.
`62`	Two surgeons	Use when two qualified clinicians share responsibility for a procedure (infrequent for spirometry).
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist service	Use when an assistant at surgery or an advanced practitioner performs or assists with the service per payer rules.
`CO`	Worker’s compensation	Use when the service is related to worker’s compensation claim adjudication.
`CQ`	Service furnished under certain programs (e.g., Public Health)	Use when required by program-specific billing rules.
`FX`	Procedures performed on both sides and billed once	Use when a bilateral modifier is required by payer for a paired procedure (uncommon for spirometry).
`FY`	Used to identify services not paid by Medicare under specific conditions	Use when billing to non-Medicare payers with specific program rules.
`QK`	Medical direction of two or more assistants at surgery	Use when medical direction qualifications apply (rare for spirometry).
`QX`	Ordered by the physician - services performed by a PA	Use when services are furnished by a physician assistant under physician order.

Taxonomy Code	Specialty	Notes
`207RC0000X`	Pulmonary Disease	Pulmonologists commonly order, interpret, and document spirometry and related diagnostic assessment.
`207RP1001X`	Internal Medicine	Internists provide longitudinal care and often manage diagnostic spirometry for COPD/asthma assessment.
`363L00000X`	Respiratory Therapy	Respiratory therapists perform and quality-control office spirometry testing.
`207QG0300X`	Family Medicine	Family physicians frequently order and interpret spirometry in outpatient settings.
`367A00000X`	Nurse Practitioner	Nurse practitioners in primary care or pulmonary clinics may perform interpretation and documentation relevant to `M1213`.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`J44.9`	Chronic obstructive pulmonary disease, unspecified	Common indication for spirometry to confirm or monitor airflow obstruction; absence of prior obstructive spirometry makes reassessment relevant.
`J45.909`	Unspecified asthma, uncomplicated	Spirometry is used to assess for obstructive physiology and bronchodilator responsiveness when asthma is suspected.
`R06.02`	Shortness of breath	Symptom prompting spirometric evaluation to determine obstructive vs. non-obstructive patterns.
`R05`	Cough	Persistent cough often prompts pulmonary function testing to evaluate for COPD or asthma.
`Z72.0`	Tobacco use, current	Smoking history is a risk factor for COPD and commonly documented in spirometry-related visits.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`94010`	Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement(s), with interpretation and report	Primary diagnostic spirometry performed in the office; often performed alongside documentation for `M1213`.
`94060`	Bronchodilator responsiveness, spirometry as in `94010`, pre- and post-bronchodilator administration and interpretation	Performed when bronchodilator response is assessed to distinguish reversible airway obstruction; may follow initial spirometry that is non-obstructive.
`94760`	Noninvasive ear or pulse oximetry for oxygen saturation; single determination	Often used adjunctively during pulmonary function testing visits for safety monitoring.
`94640`	Pressurized or nonpressurized inhalation treatment for acute airway obstruction; nebulizer therapy	May be provided if testing identifies reversible obstruction or acute symptoms requiring treatment during the visit.
`99000`	Handling and/or conveyance of specimen for transfer from the office to a laboratory	Administrative code occasionally used for specimen handling when performed in the same visit (rarely applicable to spirometry).