M1223 Glaucoma Plan of Care (HCPCS) Reimbursement | OpenPayer

Summary & Overview

HCPCS M1223: Glaucoma Plan of Care Documented

HCPCS Level II code M1223 denotes documentation of a glaucoma plan of care — a structured record of assessment, treatment objectives, and follow-up for patients with glaucoma. Nationally, standardized documentation supports care continuity, quality measurement, and appropriate billing across ophthalmology and optometry practices. This code is relevant for outpatient eye-care settings where care plans guide intraocular pressure control, monitoring intervals, medication management, and consideration of procedural interventions.

Key payers included in this overview are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication outlines how M1223 is used in billing workflows, common modifiers seen with related services, and the clinical context that underpins plan-of-care documentation. Readers will find benchmarks for utilization where available, explanations of clinical intent, and notes on billing and coding implications for outpatient ophthalmic services. Topics cover when a documented glaucoma care plan may be expected in the medical record, typical sites where the service occurs, and how payers may recognize this documentation for coverage and quality reporting.

Data not available in the input for payer-specific rates, associated taxonomies, ICD-10 pairings, and related codes.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareM1223HCPCS Level IIglaucomaophthalmologycare planoutpatientdocumentationmedical billing

Billing Code Overview

HCPCS Level II code M1223 documents a glaucoma plan of care. This code represents the formal recording of a care plan specific to glaucoma management, reflecting assessment, treatment goals, and planned follow-up.

Service type: Glaucoma care planning and documentation
Typical site of service: Ophthalmology or optometry clinic, ambulatory surgical center, or other outpatient eye care settings

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A 68-year-old patient with a history of primary open-angle glaucoma presents to an ophthalmology clinic for routine follow-up after initiation of topical intraocular pressure–lowering therapy. The clinician documents a comprehensive glaucoma plan of care that includes baseline and interval intraocular pressure measurements, visual field testing schedule, optic nerve imaging interval, target intraocular pressure, medication regimen with adherence counseling, monitoring plan for medication side effects, and follow-up visit timing. The workflow begins with visual acuity and tonometry by technical staff, review of prior imaging and visual fields, slit-lamp and fundus examination by the ophthalmologist or optometrist, documentation of clinical findings, formulation of the individualized glaucoma care plan, and entry of the plan into the medical record. The documented plan of care may be used to support billing of the glaucoma plan of care service when separate reporting is appropriate and when payer policy permits documentation-based HCPCS Level II code M1223 for a glaucoma plan of care.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when work required to document the glaucoma plan of care is substantially greater than typical due to medical complexity or extensive documentation.

HCPCS M1458: Patient Died Prior to End of Performance Period

HCPCS-M1367-ENT-QUALITY-CARE-MIPS-VALUE-PATHWAY

HCPCS M1367: Quality Care for ENT Disorders MIPS Value Pathway

HCPCS-M1473-ASSESSMENT-IMPACTING-FUNCTIONAL-MEASURE-VALIDITY

HCPCS M1473: Factors Affecting Validity of Functional/Cognitive Assessments

HCPCS-M1297-BMI-NOT-DOCUMENTED-MEDICAL-REASON-OR-PATIENT-REFUSAL

HCPCS M1297: BMI Not Documented Due to Medical Reason or Patient Refusal

HCPCS-M1253-AMBULATORY-PALLIATIVE-CARE-PATIENT-DISAVOWAL

HCPCS M1253: Ambulatory Palliative Care Patient Disavowal

HCPCS-M1343-PAM-LEVEL-4-OR-INVALID-RESPONSE-ASSESSMENT

HCPCS M1343: Assessment for PAM Level 4 or Invalid PAM Responses

HCPCS-M1284-INSTITUTIONAL-SNP-LONG-TERM-CARE-66-PLUS

HCPCS M1284: Institutional SNP or Long-Term Care Residency, Age 66+

HCPCS-M1357-FOLLOW-UP-REDUCTION-IN-SUICIDAL-IDEATION-OR-BEHAVIOR

HCPCS Level II M1357: Reduction in Suicidal Ideation or Behavior

HCPCS-M1387-PATIENT-DEATH-DURING-PERFORMANCE-PERIOD

HCPCS Level II M1387: Patient Death During Performance Period

HCPCS-M1279-ELEVATED-BLOOD-PRESSURE-READING-NO-FOLLOW-UP-DOCUMENTED

HCPCS Level II M1279: Elevated Blood Pressure Reading, No Follow-Up Documented

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Taxonomy Code	Specialty	Notes
`207RX0700X`	Ophthalmology	Ophthalmologists commonly document and direct glaucoma plans of care, including medical and surgical management.
`163W00000X`	Optometry	Optometrists perform glaucoma monitoring, document care plans, and manage stable glaucoma in many clinical settings.
`207L00000X`	Ophthalmic Plastic and Reconstructive Surgery	Subspecialists may document glaucoma-related periocular surgical plans when eyelid or adnexal procedures affect glaucoma care.
`2084P0800X`	Physician Assistant	Physician assistants in ophthalmology clinics frequently document components of the glaucoma plan of care under supervising physician arrangements.
`363LA2200X`	Nurse Practitioner	Nurse practitioners in ophthalmic practices document follow-up plans, medication counseling, and monitoring schedules for glaucoma patients.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`H40.11X1`	Primary open-angle glaucoma, right eye, mild stage	Primary open-angle glaucoma is a common indication for a documented glaucoma plan of care to manage IOP, testing intervals, and therapy.
`H40.11X2`	Primary open-angle glaucoma, right eye, moderate stage	Moderate disease severity influences target IOP and monitoring frequency documented in the plan of care.
`H40.11X3`	Primary open-angle glaucoma, right eye, severe stage	Severe glaucoma requires more intensive monitoring and possibly surgical planning documented in the care plan.
`H40.2210`	Primary angle-closure glaucoma, unspecified eye	Angle-closure glaucoma requires specific procedural and monitoring plans often captured in the glaucoma plan of care.
`H40.51`	Glaucoma secondary to eye trauma	Secondary glaucomas require addressing underlying cause and tailored follow-up documented in the plan.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`92014`	Ophthalmological services: established patient; comprehensive, with initiation of diagnostic and treatment program, typically including tonometry and slit-lamp exam	Often performed during the same visit when a glaucoma plan of care is documented for an established patient requiring comprehensive reassessment.
`92083`	Visual field examination, full threshold or suprathreshold test, with interpretation and report (per eye)	Visual field testing commonly informs the glaucoma plan of care and is scheduled or reviewed when documenting disease progression and treatment goals.
`92133`	Scanning computerized ophthalmic diagnostic imaging, posterior segment, with interpretation and report; optic nerve	Optical coherence tomography of the optic nerve is frequently used to monitor glaucoma and to guide the documented plan of care.
`99214`	Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity	E/M visits are commonly billed alongside documentation of a glaucoma plan of care when medical decision-making supports ongoing management.
`66170`	Iridotomy by laser	Laser procedures for angle-closure or other glaucoma indications may be performed with a documented plan of care that outlines perioperative and follow-up management.
`65820`	Trabeculectomy or goniotomy-related procedures (selective laser trabeculoplasty has its own code `65855`)	Surgical intervention codes are related when the glaucoma plan of care documents surgical planning, informed consent, and postoperative follow-up.

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