M1267 Kidney Transplant Waitlist | HCPCS Reimbursement | OpenPayer

Summary & Overview

HCPCS Level II M1267: Kidney/Kidney-Pancreas Transplant Waitlist Inactive Status

HCPCS Level II code M1267 identifies patients who were not in active status on any kidney or kidney–pancreas transplant waitlist at the last day of each month during a measurement period. The code documents monthly non-active waitlist status, an administrative indicator used by transplant programs, payers, and quality reporting entities to track eligibility and program-level waitlist dynamics. Nationally, consistent measurement of waitlist activity informs transplant center reporting, resource planning, and quality monitoring.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the code’s purpose and service context, national relevance for transplant program reporting, and what to expect from payer coverage patterns. The publication outlines typical uses for program administration and quality measurement and highlights where additional data would be needed for claims-level benchmarking. Data not available in the input will be noted when relevant.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareM1267HCPCS Level IIkidney transplanttransplant waitlistquality measurementtransplant program reportingoutpatient administrationwaitlist status

Billing Code Overview

HCPCS Level II code M1267 indicates patients who were not observed in active status on any kidney or kidney-pancreas transplant waitlist as of the last day of each month during the measurement period. This measure captures monthly active-waitlist status for patients eligible for kidney or kidney-pancreas transplantation.

Service type: Transplant waitlist status measurement and reporting
Typical site of service: Transplant center outpatient reporting or transplant program administrative records

Clinical & Coding Specifications

Clinical Context

A patient with end-stage renal disease (ESRD) has been evaluated for kidney transplantation and was listed on a transplant center’s registry but, during the measurement month, the patient was recorded as not active on any kidney or kidney–pancreas transplant waitlist. Typical reasons include temporary medical contraindications (infection, recent malignancy treatment), psychosocial or insurance barriers, incomplete testing, or patient-requested inactivation. The clinical workflow begins with transplant clinic staff reviewing monthly registry status. When a patient is placed in an inactive status, the transplant coordinator documents the reason in the medical record, updates the transplant registry status for the last day of the month, and communicates with the dialysis unit and referring nephrologist. Billing or reporting staff track patients who are not active on the waitlist at month-end for quality measurement and registry reporting purposes. Communication across the multidisciplinary team (transplant surgeon, nephrologist, transplant coordinator, social work) and documentation of the inactivation rationale are typical components of the encounter.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when additional work or complexity related to transplant evaluation documentation is substantial and separately reportable for billable procedures associated with evaluation visits.

HCPCS M1393: Nonrecurrent Melanoma Status

HCPCS-M1188-CHRONIC-KIDNEY-DISEASE-STAGE-5-MANAGEMENT

HCPCS Level II M1188: Chronic Kidney Disease Stage 5

HCPCS-M1215-DOCUMENTATION-MEDICAL-REASON-NO-SPIROMETRY-REVIEW

HCPCS M1215: Documentation of Medical Reason for Not Reviewing Spirometry Results

HCPCS-M1257-CVD-RISK-ASSESSMENT-NOT-PERFORMED-OR-INCOMPLETE

HCPCS Level II M1257: CVD Risk Assessment Not Performed or Incomplete

HCPCS-M1413-PD-L1-POSITIVE-PRE-FIRST-LINE-IMMUNOTHERAPY

HCPCS M1413: PD-L1 Positive Prior to First-Line Immune Checkpoint Inhibitor Therapy

HCPCS-M1243-PATIENT-FELT-HEARD-UNDERSTOOD

HCPCS Level II M1243: Patient-Reported Feeling Heard and Understood

HCPCS-M1460-RESPIRATORY-DIAGNOSES-COPD-EMPHYSEMA-CYSTIC-FIBROSIS-ARF

HCPCS Level II M1460: Respiratory Diagnoses — COPD, Emphysema, Cystic Fibrosis

HCPCS-M1175-DOCUMENTATION-ZOSTER-VACCINE-CONTRAINDICATION

HCPCS Level II M1175: Documentation of Medical Reason for Not Administering Zoster Vaccine

HCPCS-M1182-IBD-INELIGIBILITY-PRE-EXISTING-INFLAMMATORY-BOWEL-DISEASE

HCPCS M1182: Ineligibility Due to Pre-existing Inflammatory Bowel Disease

HCPCS-M1329-POST-OPERATIVE-ACUTE-PVD-EYE-ENCOUNTER

HCPCS M1329: Post-Operative Encounter for Acute Posterior Vitreous Detachment

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Taxonomy Code	Specialty	Notes
2080S0105X	Transplant Surgery	Primary surgical specialty performing kidney and kidney–pancreas transplants.
207RC0000X	Nephrology	Medical specialty managing ESRD patients and transplant candidacy evaluation.
363L00000X	Nurse Coordinator	Transplant coordinator/clinical nurse specialists managing waitlist status and documentation.
2084N0400X	Social Worker	Provides psychosocial assessment and clearance related to transplant active/inactive decisions.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`N18.6`	End stage renal disease	Primary diagnosis indicating need for kidney transplant evaluation and listing.
`Z94.0`	Kidney transplant status	Relevant for patients with prior transplants being considered for re-transplant or status updates.
`Z76.89`	Other specified persons encountering health services for specific procedures and health care	Used for administrative encounters related to transplant listing and status assessment.
`Z53.1`	Procedure and treatment not carried out because of patient decision for other and unspecified reasons	May apply when a patient requests temporary inactivation from the waitlist.
`T81.4XXA`	Infection following a procedure, initial encounter	Represents complications that may necessitate temporary inactivation from the waitlist.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99214`	Office or other outpatient visit, established patient, moderate complexity	Frequently used for transplant clinic visits where active/inactive listing status is reviewed and documented.
`36415`	Collection of venous blood by venipuncture	Commonly performed for required laboratory testing during transplant evaluation leading to active/inactive status decisions.
`83036`	Hemoglobin; glycohemoglobin (A1c)	Used when assessing diabetes control which can affect transplant candidacy and waitlist activation.
`76700`	Ultrasound, abdominal, real time with image documentation (complete)	May be used for pretransplant imaging of native kidneys or pelvis as part of evaluation before activation.
`99354`	Prolonged physician service in the outpatient setting, first hour (face-to-face)	Applied when extended counseling or complex case management discussions occur during listing status determination.

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