HCPCS M1272: Kidney or Kidney-Pancreas Transplant Waitlist Membership - OpenPayer

Summary & Overview

HCPCS M1272: Kidney or Kidney-Pancreas Transplant Waitlist Membership

HCPCS Level II code M1272 designates patients who are on any kidney or kidney-pancreas transplant waitlist on the last day of each month within a measurement period. The code supports administrative tracking of transplant waitlist prevalence and program-level reporting, which is important for capacity planning, outcome monitoring, and meeting registry or payer reporting requirements at a national scale. This metric matters nationally because transplant waitlist dynamics inform resource allocation, policy decisions, and evaluation of transplant program performance.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find context on what the code represents clinically and operationally, typical sites where the service is recorded, and how this code is used for longitudinal waitlist measurement. The publication provides benchmarks and reporting context where available, summarizes relevant policy and administrative considerations, and situates the code within transplant program workflows. Data not available in the input will be clearly indicated in sections where specifics (such as associated taxonomies, ICD-10 mappings, or related codes) are required.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareM1272HCPCS Level IItransplant waitlistkidney transplantkidney-pancreas transplanttransplant registryadministrative reportingtransplant program

Billing Code Overview

HCPCS Level II code M1272 identifies patients who are observed on any kidney or kidney-pancreas transplant waitlist as of the last day of each month during the measurement period. This billing descriptor captures a registry or administrative status used to track transplant waitlist presence over time.

Service type: Transplant waitlist membership tracking and reporting
Typical site of service: Transplant centers, hospital transplant programs, and associated administrative or registry reporting systems

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

Service: Observation of patients listed on kidney or kidney–pancreas transplant waitlists as of the last day of each month during the measurement period (M1272).

A typical patient is a 52-year-old with end-stage renal disease (ESRD) receiving routine care at a transplant center. The patient attends monthly clinic visits for dialysis and transplant evaluation. Clinic staff confirm active placement on the kidney transplant waitlist and document clinical stability, immunologic status, and any changes affecting candidacy (for example, new infections, malignancy, or nonadherence). The workflow includes verifying the patient appears on the organ procurement organization (OPO) or transplant registry waitlist on the last day of the month, documenting the verification in the medical record, and reporting the observation for quality measurement and registry submission.

Typical site of service: transplant center outpatient clinic, dialysis center coordination office, or hospital-based transplant program administrative office.

Common patient interactions include previsit review of the transplant registry status, telephonic or electronic confirmation with the transplant coordinator, updated clinical notes in the electronic health record, and monthly administrative aggregation of waitlist counts for reporting and quality measures.

Coding Specifications

Modifier	Description	When to Use

Related Codes

HCPCS-M1164-DEMENTIA-HISTORY-MEASURE

HCPCS M1164: Dementia Documented in Patient History

HCPCS-M1400-PATIENT-DEATH-DURING-FOLLOW-UP

HCPCS M1400: Patients Who Died During Follow-Up

HCPCS-M1197-ITCH-SEVERITY-ASSESSMENT-SCORE-IMPROVEMENT

HCPCS M1197: Itch Severity Assessment, 3+ Point Improvement

HCPCS-M1484-NO-REPEAT-HCV-RNA-LABS-MEDICAL-REASON

HCPCS Level II M1484: No Repeat HCV RNA Labs, Medical Reason

HCPCS-M1393-NONRECURRENT-MELANOMA-STATUS

HCPCS M1393: Nonrecurrent Melanoma Status

HCPCS-M1339-FOLLOW-UP-FUNCTIONAL-ASSESSMENT-IMPROVEMENT-MAINTENANCE

HCPCS Level II M1339: Follow-Up Functional Assessment (30–180 Days)

HCPCS-M1239-PATIENT-DID-NOT-RESPOND-TO-HEARD-AND-UNDERSTOOD-QUESTION

HCPCS Level II M1239: Patient Did Not Respond to 'Heard and Understood' Question

HCPCS-M1453-PRE-OPERATIVE-VISUAL-ACUITY-BETTER-THAN-20-40

HCPCS M1453: Pre-operative Visual Acuity Better Than 20/40

HCPCS-M1280-BILATERAL-MASTECTOMY-HISTORY

HCPCS Level II M1280: Bilateral Mastectomy or History of Bilateral Mastectomy

HCPCS-LEVEL-II-M1255-POSITIVE-PREGNANCY-TEST-NON-OB-VISIT

HCPCS Level II M1255: Positive Pregnancy Test During Non-Obstetric Clinic Visit

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Taxonomy Code	Specialty	Notes
`2080S0004X`	Transplant Surgery	Primary specialty managing transplant waitlist operations and surgical evaluation.
`207P00000X`	Nephrology	Manages ESRD patients, dialysis coordination, and transplant candidacy assessment.
`207K00000X`	Internal Medicine	Provides primary care and medical optimization for transplant candidates.
`3336S0105X`	Organ Procurement Organization Specialist	Coordinates waitlist verification and organ allocation communications.
`363L00000X`	Nursing — Transplant Coordinator	Performs routine monthly verification and documentation tasks.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`N18.6`	End stage renal disease	Primary diagnosis for most patients on the kidney transplant waitlist; defines transplant candidacy.
`Z94.0`	Kidney transplant status	Used for patients with prior transplant; relevant for re-listing or waitlist status tracking.
`Z94.83`	Pancreas transplant status	Relevant when kidney–pancreas transplant waitlisting is tracked.
`E10.21`	Type 1 diabetes mellitus with diabetic nephropathy	Common comorbidity leading to combined kidney–pancreas transplant listing.
`I50.9`	Heart failure, unspecified	Relevant comorbidity that may impact transplant candidacy and monthly verification decisions.
`Z76.89`	Other problems related to lifestyle or economic circumstances	May be used to document social determinants affecting candidacy, for example, transportation barriers.
`Z99.2`	Dependence on renal dialysis	Documents ongoing dialysis dependency and is pertinent to waitlist monitoring.
`C80.1`	Malignant neoplasm, unspecified — baseline for documenting active malignancy status	Presence of active malignancy affects transplant eligibility and is reviewed during monthly verification.

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	Commonly used for monthly clinic visits where waitlist status is reviewed and documented.
`99457`	Remote evaluation of recorded video and/or asynchronous images or remote physiologic monitoring treatment management services, 20 minutes or more	May be used when monthly verification and coordination occur via remote monitoring or asynchronous review.
`99490`	Chronic care management services, at least 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month	Used when comprehensive monthly care management includes transplant waitlist maintenance activities.
`G0438`	Annual wellness visit, initial; face-to-face visit, per year	Not a monthly code but may be part of broader preventive care documentation tied to transplant candidacy assessments.
`CPT Not Applicable`	Data not available in the input.	If additional procedure codes are required for billing administrative registry submissions, local payer guidance applies.