M1417 HCPCS: Reimbursement & Policy Benchmarks | OpenPayer

Summary & Overview

HCPCS Level II M1417: COVID-19 Vaccination Status, Up to Date

HCPCS Level II code M1417 documents patients who are up to date on COVID-19 vaccinations per CDC recommendations. As a preventive-care status code, it supports clinical documentation of immunization completeness and can be used across ambulatory and outpatient settings where vaccination history is reviewed. Nationally, standardized capture of COVID-19 vaccination status matters for public health monitoring, care coordination, and quality measurement during and after the pandemic response.

Key payers in scope for coverage and claims-processing comparisons include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the code’s clinical purpose, expected service settings, and the common modifiers associated with billing. The publication also outlines typical use cases for documentation of vaccination status, potential implications for preventive care workflows, and what is available vs. missing in the input (for example, associated taxonomies, ICD-10 pairings, and related codes are not provided).

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareM1417HCPCS Level IICOVID-19 vaccinationpreventive carevaccination statusambulatory careoutpatient documentation

Billing Code Overview

HCPCS Level II code M1417 indicates patients who are up to date on their COVID-19 vaccinations as defined by CDC recommendations on current vaccination. The service type is vaccination status documentation / preventive care assessment, reflecting capture of a patient’s current immunization status against COVID-19.

Typical site of service for this code is ambulatory and outpatient settings, including primary care clinics, community vaccination sites, and other outpatient preventive care locations where vaccination status is assessed and recorded.

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A typical patient is a 28–65-year-old adult presenting to a primary care clinic, occupational health site, pharmacy-run vaccination clinic, or community vaccination event to confirm and document that they are up to date on COVID-19 vaccinations per current Centers for Disease Control and Prevention (CDC) recommendations. The clinical workflow begins with patient intake and verification of identity and insurance, review of the immunization history (state IIS or patient record), assessment of prior COVID-19 vaccine type(s) and dates, and determination of whether the patient meets the current CDC criteria for being up to date (age, primary series, booster intervals, and any immunocompromising conditions). Staff document the vaccination status in the electronic health record and immunization registry, provide any required counseling or educational materials, and, if applicable, administer an additional recommended dose or booster. Typical sites of service include outpatient primary care offices, retail pharmacy clinics, occupational health clinics, public health vaccination sites, and community health centers. Common patient scenarios include: patients requesting documentation for employment, travel, school, or personal health records; patients seeking verification prior to scheduled procedures; and patients attending routine visits who receive status confirmation and counseling. The service captures verification and documentation rather than a separate, complex clinical procedure; time spent may include chart review, patient counseling, and registry entry.

Coding Specifications

Modifier	Description	When to Use
`22`

HCPCS Level II M1287: BMI Below Normal with Documented Follow-Up Plan

HCPCS-M1275-HOSPICE-EXCLUSION-REPORTING-PERIOD

HCPCS M1275: Hospice Exclusion From Evaluation and Reporting

HCPCS-M1329-POST-OPERATIVE-ACUTE-PVD-EYE-ENCOUNTER

HCPCS M1329: Post-Operative Encounter for Acute Posterior Vitreous Detachment

HCPCS-M1422-GASTROENTEROLOGY-MIPS-VALUE-PATHWAY

HCPCS M1422: Gastroenterology Care MIPS Value Pathway

HCPCS-M1447-BIPOLAR-DISORDER-DIAGNOSIS-MEASURE

HCPCS Level II M1447: Bipolar Disorder Diagnosis Measure

HCPCS-M1238-RECOMBINANT-ZOSTER-DELAYED-SECOND-DOSE-DOCUMENTATION

HCPCS Level II M1238: Documentation of Delayed Second Recombinant Zoster Dose

HCPCS-M1160-MENINGOCOCCAL-VACCINE-ANAPHYLAXIS-BEFORE-AGE-13

HCPCS M1160: Anaphylaxis from Meningococcal Vaccine Before Age 13

HCPCS-M1319-CSP-CONTACT-AFTER-POSITIVE-HRSN-SCREENING

HCPCS M1319: CSP Contact After Positive High-Risk Screening

HCPCS-M1434-ORAL-CHEMOTHERAPY-STATUS-POST-ENCOUNTER

HCPCS M1434: Patient on Oral Chemotherapy Near Encounter

HCPCS-M1426-TELEHEALTH-ENCOUNTER-VIRTUAL-VISIT

HCPCS M1426: Telehealth Encounter, Virtual Visit

Showing 1–10 of 356

Taxonomy Code	Specialty	Notes
`207Q00000X`	Family Medicine	Primary care clinicians who commonly verify and document immunization status.
`207R00000X`	Internal Medicine	Adult primary care physicians performing status review and counseling.
`363L00000X`	Public Health & General Preventive Medicine	Public health clinicians and vaccination program staff documenting population immunizations.
`367A00000X`	Preventive Medicine	Clinicians focused on immunization strategy and documentation.
`3336C0002X`	Clinical Pharmacist	Pharmacists and vaccine clinic pharmacists who verify and document vaccination status.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`Z28.310`	Underimmunization status for COVID-19 vaccine	Applicable when a patient is not up to date and needs vaccination; used when documenting immunization gaps.
`Z28.39`	Other underimmunization status	Used when patient immunization status requires updating for vaccines other than specifically listed codes.
`Z23`	Encounter for immunization	Used when the visit includes encounter for immunization or verification of immunization status.
`Z71.89`	Other specified counseling	Used when counseling about COVID-19 vaccination status and recommendations is provided.
`Z00.129`	Encounter for routine child health examination without abnormal findings	For pediatric visits where up-to-date status is assessed (if applicable by age).
`Z00.00`	Encounter for general adult medical examination without abnormal findings	For adult preventive visits that include immunization status verification.
`Z02.79`	Encounter for administrative examinations, other	Used when documentation is requested for administrative reasons (employment, travel, school).

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`90471`	Immunization administration (single vaccine), intramuscular or subcutaneous, per vaccine	Used when a COVID-19 vaccine dose is administered at the same encounter as status verification.
`90472`	Immunization administration, each additional vaccine (same visit)	Used when additional vaccines are given during the same visit in addition to the COVID-19 vaccine.
`G0008`	Administration of influenza vaccine, all ages, by single injection (Medicare-specific historically)	May be used by some payors for influenza; listed as a comparable immunization administration code when multiple vaccines are documented in an immunization visit.
`99401`	Preventive medicine counseling, individual, low to moderate complexity (short) (historical payer-specific use)	Use when brief counseling about vaccine recommendations and up-to-date status is provided (note many payors use different billing pathways).
`99381`	Initial comprehensive preventive medicine evaluation and management of an individual including age and gender appropriate history, examination, counseling (new patient)	May be billed when a full preventive medicine visit is performed that includes immunization status documentation as part of the comprehensive exam.

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