Summary & Overview
HCPCS M1214: Spirometry with Confirmed Airflow Obstruction, Documented and Reviewed
HCPCS Level II code M1214 denotes documentation and clinical review of spirometry demonstrating confirmed airflow obstruction (FEV1/FVC < 70%). This code captures the formal recording that an obstructive pattern was present and that results were reviewed by a clinician. Nationally, accurate capture of objective pulmonary function results is important for quality measurement, care coordination for obstructive lung disease, and tracking use of diagnostic testing across outpatient settings.
Key payers referenced in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of what the code represents, the typical service setting, and why coding matters for reporting and clinical documentation. The publication outlines common modifiers associated with similar service lines, typical sites of service, and guidance on where this code fits in clinical workflows. It also highlights benchmarking and policy context where available and notes when source inputs were not provided. The goal is to give clinicians, coders, and policy analysts a clear, practical summary of HCPCS Level II code M1214 for national-level planning and documentation purposes.
Billing Code Overview
HCPCS Level II code M1214 documents spirometry results with confirmed airflow obstruction defined as FEV1/FVC < 70% that have been documented and reviewed. The service represents the formal recording and clinical review of spirometric testing indicating obstructive ventilatory defect.
Service type: Pulmonary function testing result review and documentation
Typical site of service: Outpatient pulmonary function laboratory or clinic, including primary care or specialty pulmonary practices where spirometry is performed and interpreted.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 62-year-old patient with a long smoking history and progressive exertional dyspnea presents to a outpatient pulmonary function testing lab or a primary care clinic for evaluation of suspected chronic obstructive pulmonary disease (COPD). The clinician orders spirometry. The test is performed by trained respiratory therapy staff in a clinic, hospital outpatient department, or ambulatory diagnostic center. Spirometry maneuvers are coached and repeated to obtain reproducible forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) values. Results demonstrate a post-bronchodilator FEV1/FVC ratio < 70%, consistent with confirmed airflow obstruction. The interpreting clinician documents the abnormal spirometry values, confirms obstruction, reviews results with the patient, and incorporates findings into the treatment plan (for example, initiation or adjustment of inhaled bronchodilator therapy and follow-up planning). Typical sites of service include outpatient pulmonary function laboratories, hospital outpatient departments, primary care clinics with PFT capability, and ambulatory surgery centers when testing is pre- or post-procedure. Common payer interactions include prior authorization for complex testing by commercial payors such as Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare, and submission of the HCPCS Level II code M1214 with appropriate date-of-service, modifier(s), and supporting documentation in the medical record.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 |