M1268 HCPCS: Waitlist Reimbursement & Policy

HCPCS Level II code M1268 designates patients who are in active status on any kidney or kidney–pancreas transplant waitlist as of the last day of each month during the measurement period. As a registry and program reporting code, it supports tracking of transplant waitlist populations and program-level measurement nationally. Consistent capture of active waitlist status is important for transplant program oversight, capacity planning, and quality measurement across care networks.

Key payers considered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of what HCPCS Level II code M1268 represents, the clinical and administrative context for its use, and the typical sites of service where the code applies. The publication summarizes national relevance and utility for transplant programs and payers, outlines standard reporting roles for the code, and highlights where data is available versus where input did not provide additional fields. Data not available in the input is noted explicitly.

This piece is intended to inform billing, coding, and policy teams about the purpose and scope of HCPCS Level II code M1268, how it fits into transplant program measurement, and which major payers commonly interact with this kind of reporting.

Billing Code Overview

HCPCS Level II code M1268 identifies patients who are 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 a registry or administrative count of patients maintained in active transplant waitlist status for kidney or combined kidney–pancreas transplants.

Service type: Transplant waitlist status measurement and registry reporting
Typical site of service: Transplant centers and transplant program administrative/registry settings

Clinical Context

A 52-year-old patient with end-stage renal disease (ESRD) is being evaluated and maintained on the kidney transplant waitlist. The transplant center conducts monthly administrative and clinical reconciliation to confirm active waitlist status. On the last day of each month during the measurement period, the patient’s chart is reviewed to verify they remain in an "active" status (eligible and available for organ offer). Typical workflow: outpatient transplant coordinator or registry specialist queries the transplant registry and electronic health record (EHR) to confirm active status; documents clinical eligibility (e.g., no new contraindications, current immunizations, up-to-date cardiovascular clearance) and social readiness; updates the transplant information system; and communicates status to the multidisciplinary team. Typical site of service: transplant center outpatient clinic or transplant program administrative office. Service type: registry/administrative encounter and status verification for transplant waitlist maintenance. Typical patient scenario: patient attends routine transplant follow-up, lab results and cardiology clearance are reviewed, barriers to transplantation (active infection, recent malignancy, nonadherence) are assessed and none are present, and the coordinator documents the patient as active on the kidney transplant waitlist as of the last day of the month.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when reporting substantially greater work than typical for an associated service (rare for administrative waitlist reporting).

Taxonomy Code	Specialty	Notes
`207L00000X`	Transplant Surgery	Primary specialty managing candidate evaluation and waitlist decisions.
`207LP2900X`	Nephrology	Medical management of ESRD and transplant candidacy.
`208000000X`	General Internal Medicine	Primary care coordination and comorbidity management in transplant candidates.
`363A00000X`	Physician Assistant	Common provider type assisting coordinators and clinics in status verification.
`371K00000X`	Nursing — Registered Nurse	Transplant coordinator and clinic nursing staff performing documentation and follow-up.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`N18.6`	End stage renal disease	Primary diagnosis indicating need for kidney transplant and placement on the transplant waitlist.
`Z94.0`	Kidney transplant status	Relevant when documenting prior transplant status or considering re-transplant candidacy; may influence active waitlist decisions.
`Z48.21`	Encounter for aftercare following kidney transplant	Relevant for patients with prior transplant who may be relisted or monitored.
`Z99.2`	Dependence on renal dialysis	Indicates ongoing dialysis dependence; commonly present in active transplant candidates.
`I50.9`	Heart failure, unspecified	Common comorbidity influencing transplant eligibility and perioperative risk assessment.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99213`	Office or other outpatient visit for the evaluation and management of an established patient, typically 15 minutes	Used for routine transplant follow-up visits where active status is assessed and documented.
`99339`	Home visit for established patient, established patient home visit (example billing; actual code choice varies)	May be used when pretransplant evaluation or status confirmation occurs in the patient’s home for limited circumstances.
`99499`	Unlisted evaluation and management service	Used for atypical or nonstandard administrative encounters related to registry or complex coordination when no specific code fits.
`36415`	Collection of venous blood by venipuncture	Frequently performed during transplant clinic visits for required labs as part of candidate monitoring.
`93000`	Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report	Cardiac evaluation commonly performed in transplant candidate clearance workflows and documented alongside status verification.

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Summary & Overview

HCPCS M1268: Kidney or Kidney–Pancreas Transplant Waitlist Active Status