Summary & Overview
HCPCS Level II M1306: Anaphylaxis Due to Pneumococcal Vaccine
HCPCS Level II code M1306 denotes a documented history of anaphylaxis due to the pneumococcal vaccine that occurred anytime during or prior to the measurement period. This clinical-status code is used to flag patients with a severe vaccine-related allergic event and is important for patient safety, immunization planning, and quality measurement. Nationally, consistent use of the code helps track vaccine contraindications, informs clinical decisions about future pneumococcal vaccination, and supports quality reporting tied to immunization measures.
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 clinical meaning, typical service settings, and the types of benchmarks and policy considerations commonly associated with documenting vaccine-related anaphylaxis. The publication outlines where this code appears in quality measurement workflows, how payers commonly handle documentation of vaccine contraindications, and the implications for reporting and patient records management. Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes.
Billing Code Overview
HCPCS Level II code M1306 indicates that a patient had anaphylaxis due to the pneumococcal vaccine any time during or before the measurement period. This code documents a documented history of severe allergic reaction to a pneumococcal vaccination.
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Service type: Allergy/immunization adverse event documentation
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Typical site of service: Outpatient clinic, primary care office, urgent care, emergency department, or immunization clinic
Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes.
Clinical & Coding Specifications
Clinical Context
A 28-year-old patient presents to an outpatient primary care clinic reporting a severe, immediate hypersensitivity reaction within minutes to hours after receiving a pneumococcal vaccine several months prior. The reaction included urticaria, angioedema and hypotension requiring emergency department stabilization with intramuscular epinephrine and intravenous fluids. During a subsequent follow-up visit within the measurement period the clinician documents a history of anaphylaxis due to the pneumococcal vaccine, updates the problem list, and records vaccine allergy counseling and a plan to avoid future pneumococcal immunizations. The clinical workflow includes review of the ED record, verification of the reaction details, updating allergy lists in the electronic health record, coding the encounter with the appropriate HCPCS Level II code M1306 to indicate documented anaphylaxis to the pneumococcal vaccine, and communicating the allergy to the patient’s care team and pharmacy.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when additional work beyond usual is documented for management, e.g., extensive counseling or complex coordination related to vaccine anaphylaxis. |
23 |