Summary & Overview
HCPCS M1368: Prevention and Treatment of Infectious Disorders including Hepatitis C and HIV
HCPCS Level II code M1368 denotes services focused on the prevention and treatment of infectious disorders, explicitly including hepatitis C and HIV within a MIPS value pathway context. Nationally, this code reflects growing emphasis on organized screening, linkage to care, and integrated treatment management for high-priority infectious diseases that have public health and population-health implications.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of service definitions tied to M1368, typical sites of service, common modifiers used with the code, and payer coverage tendencies. The publication summarizes benchmarking points, relevant policy updates affecting coverage and reporting under value-based programs, and clinical context for how these services fit into outpatient care pathways.
This resource helps clinicians, billing specialists, and policy analysts understand where M1368 fits in clinical workflows, the types of services that map to the code, and the payer landscape that governs reimbursement and reporting. Data not available in the input will be identified explicitly where applicable.
Billing Code Overview
HCPCS Level II code M1368 covers services for the prevention and treatment of infectious disorders, including care related to hepatitis C and HIV under a MIPS value pathway framework. The code represents services centered on infectious disease prevention, screening coordination, linkage to care, and treatment management.
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Service type: Clinical preventive and disease-management services for infectious diseases, including screening, counseling, and treatment coordination.
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Typical site of service: Outpatient ambulatory clinics, infectious disease specialty clinics, community health settings, and primary care offices.
Clinical & Coding Specifications
Clinical Context
A 42-year-old patient with confirmed chronic hepatitis C infection presents to an infectious disease clinic for initiation of direct-acting antiviral therapy and ongoing monitoring as part of a population health initiative aligned with MIPS value pathways. The patient undergoes baseline evaluation including medical history, assessment of liver fibrosis (noninvasive elastography or serum fibrosis markers), laboratory testing for hepatitis C RNA, HCV genotype if indicated, HIV screening, hepatitis B surface antigen, comprehensive metabolic panel, and pregnancy test if applicable. The clinical workflow includes counseling on treatment options, prescription of an antiviral regimen, coordination with pharmacy for prior authorization, periodic laboratory monitoring during therapy (viral load at 4 weeks and at end of therapy), and post-treatment sustained virologic response testing at 12 weeks after completion. Typical visit locations are outpatient infectious disease or hepatology clinics, federally qualified health centers, community clinics, and outpatient infusion or procedure centers when ancillary services are required. Common patient scenarios include treatment initiation, management of drug–drug interactions, monitoring for adherence and adverse effects, and linkage to HIV care for coinfected individuals. Payors encountered may include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services |