M1308 HCPCS: Reimbursement & Policy Benchmarks | OpenPayer

Summary & Overview

HCPCS Level II M1308: Influenza Immunization Not Administered

HCPCS Level II code M1308 denotes that an influenza immunization was not administered, with no reason provided. Nationally, this code matters because it documents missed or declined influenza vaccinations in patient records and claims, affecting preventive care reporting, quality measurement, and population immunization surveillance. Accurate use of this code informs payer workflows, encounter records, and public health datasets.

Key payers referenced 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 context, typical sites of service, and implications for claims documentation and quality measurement. The publication summarizes common modifier practice in claims submission and highlights where data is not available in the input.

This report is intended for national audiences including billing managers, compliance officers, clinician administrators, and policy analysts interested in immunization documentation and preventive service coding.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareM1308HCPCS Level IIinfluenza immunizationvaccine documentationpreventive servicesoutpatient codingclaims documentationquality measurement

Billing Code Overview

HCPCS Level II code M1308 indicates influenza immunization was not administered, reason not given. The service type is vaccine administration/preventive services recorded as not administered. The typical site of service is outpatient or ambulatory care settings where immunizations are ordinarily offered, such as primary care clinics, urgent care centers, pharmacy-based clinics, and public health vaccination sites.

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A patient presents to a primary care clinic during influenza season for a routine office visit. During triage, staff document that the patient did not receive the influenza immunization at this encounter and no reason for refusal or omission is recorded. The clinician updates the problem list and encounter note to reflect that influenza immunization was not administered; the encounter may include evaluation and management for an unrelated complaint (e.g., hypertension follow-up or acute upper respiratory symptoms). The billing department assigns HCPCS Level II code M1308 to indicate that the influenza immunization was not administered — reason not given. Typical workflow includes documentation in the electronic health record that vaccine was offered or considered, marking immunization status, and coding the encounter for quality reporting and immunization tracking purposes.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when clinical work or complexity for the visit was substantially greater than typical and documented (rare for vaccine omission but applicable to a complex E/M visit accompanying the documentation).
`23`

HCPCS M1349: No Net PAM Score Improvement (4–12 Month Follow-Up)

HCPCS-M1494-PATIENT-REPORTED-FALL-SINCE-LAST-VISIT

HCPCS Level II M1494: Patient Reported Fall Since Last Visit

HCPCS-M1240-PATIENT-NO-RESPONSE-PROVIDER-BEST-INTERESTS-QUESTION

HCPCS M1240: Patient Nonresponse to Provider Best-Interests Question

HCPCS-M1396-THERAPEUTIC-CLINICAL-TRIAL-PATIENT

HCPCS M1396: Patients on a Therapeutic Clinical Trial

HCPCS-M1219-ANAPHYLAXIS-VACCINE-REACTION-ENCOUNTER

HCPCS Level II M1219: Anaphylaxis Due to Vaccine on or Before Encounter Date

HCPCS-M1313-TOBACCO-SCREENING-NOT-PERFORMED

HCPCS M1313: Tobacco Screening or Cessation Intervention Not Performed

HCPCS-M1364-ASCVD-10-YEAR-RISK-20-PERCENT-OR-GREATER

HCPCS Level II M1364: 10-Year ASCVD Risk Score ≥20%

HCPCS-M1154-HOSPICE-SERVICES-MEASUREMENT-PERIOD

HCPCS M1154: Hospice Services During Measurement Period

HCPCS-LEVEL-II-M1503-VASCULAR-SURGERY-MIPS-VALUE-PATHWAY

HCPCS Level II M1503: Vascular Surgery MIPS Value Pathway

HCPCS-M1452-PATIENT-HISTORY-DEMENTIA

HCPCS M1452: Patient Ever Had a Diagnosis of Dementia

Showing 1–10 of 356

Taxonomy Code	Specialty	Notes
`208000000X`	Family Medicine	Primary setting for routine immunization offers and documentation of vaccine omission.
`207Q00000X`	Internal Medicine	Adult primary care clinicians commonly document influenza vaccine status and assign `M1308` when vaccine not given.
`363L00000X`	Obstetrics & Gynecology	OB/GYN clinicians commonly assess and document influenza immunization during prenatal and routine visits.
`207L00000X`	Pediatrics	Pediatricians document immunization status; if influenza immunization is not administered and no reason documented, `M1308` may be used for reporting.
`1835S0001X`	Nursing — Advanced Practice Registered Nurse (APRN)	APRNs frequently document immunization decisions and may bill encounters where `M1308` is applied.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`Z28.0`	Immunization not carried out because of contraindication	Differentiates cases where vaccine is contraindicated from `M1308`, which indicates not administered without reason given.
`Z28.1`	Immunization not carried out because of patient refusal	Documents explicit patient refusal; contrasts with `M1308` where no reason is recorded.
`Z28.2`	Immunization not carried out because of other reasons	Captures documentation of reasons other than refusal or contraindication; may be used when a specific reason is noted instead of `M1308`.
`Z23`	Encounter for immunization	Used when the visit relates to immunization status or administration; may be present when immunization was considered but not given.
`J06.9`	Acute upper respiratory infection, unspecified	Common presenting complaint during which immunization may be deferred; visit may be coded with `M1308` if vaccine not given and no reason documented.

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	Common E/M level when a patient visit includes documentation that influenza immunization was not administered; the E/M visit may be the primary billed service.
`90460`	Immunization administration through 18 years of age via any route, with counseling by physician or other qualified health care professional; first vaccine/toxoid component	Related when vaccine administration occurs; absent for `M1308` but commonly performed when immunization is given.
`90461`	Each additional vaccine/toxoid component	Used when multiple vaccine components are administered; relevant to workflow when immunization is performed instead of using `M1308`.
`90471`	Immunization administration (single vaccine) by intramuscular, intranasal, or oral route; for vaccines administered to adults	Relevant when influenza vaccine is administered during the visit; contrasts with `M1308` when vaccine is not given.
`G0008`	Administration of influenza vaccine, including counseling, by a physician or other qualified health care professional (Medicare)	Medicare-specific administration code used when vaccine is actually given; referenced to show the typical alternative action when `M1308` is not used.

OpenPayer