Summary & Overview

HCPCS Level II M1460: Respiratory Diagnoses — COPD, Emphysema, Cystic Fibrosis

HCPCS Level II code M1460 designates a respiratory diagnosis including chronic obstructive pulmonary disease (COPD), emphysema, cystic fibrosis, or acute respiratory failure. Nationally, clear coding for acute and chronic respiratory conditions is essential for accurate clinical documentation, care coordination, and claims processing across inpatient and outpatient settings. Proper use of M1460 supports clinical communication when respiratory diagnoses drive utilization of specialized services such as oxygen therapy, ventilatory support, or advanced pulmonary care.

Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an outline of the clinical context for the code, common sites of service where this diagnosis is recorded, and the types of service lines typically associated with respiratory diagnoses. The publication also summarizes benchmark considerations and policy developments that affect coverage and billing for respiratory conditions nationally.

This summary provides clinicians, billers, and policy analysts with a concise reference to the code’s clinical scope, payer landscape, and the operational settings where M1460 is most relevant. Data not available in the input is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareM1460HCPCS Level IIrespiratory diagnosisCOPDacute respiratory failurepulmonary carehospital servicesoutpatient pulmonarycystic fibrosis

Billing Code Overview

HCPCS Level II code M1460 indicates a diagnosis for chronic obstructive pulmonary disease, emphysema, cystic fibrosis, or acute respiratory failure. This code is used to denote clinical conditions affecting the respiratory system that require monitoring, treatment planning, or specific respiratory services.

Service type: Respiratory diagnosis and management services

Typical site of service: Inpatient hospital, emergency department, and outpatient pulmonary care settings such as specialty clinics or hospital-based clinics

Clinical & Coding Specifications

Clinical Context

A 68-year-old male with a long smoking history presents to the emergency department with progressive dyspnea, increased sputum production, and hypoxemia. He has a prior diagnosis of chronic obstructive pulmonary disease (COPD) with emphysematous changes on prior imaging and a baseline home oxygen requirement. On arrival his respiratory rate is elevated, oxygen saturation is 86% on room air, and arterial blood gas demonstrates acute on chronic respiratory failure. The clinical workflow includes rapid triage, supplemental oxygen titration, bronchodilator therapy, inhaled corticosteroids as indicated, chest radiography to evaluate for acute processes, and consideration of noninvasive ventilation or intubation if respiratory status worsens. Pulmonary consultation is frequently obtained for management of acute respiratory failure in the setting of COPD/emphysema and for decisions regarding ICU admission, advanced airway management, and long-term oxygen needs. Documentation to support billing for M1460 should include the primary pulmonary diagnosis (for example, COPD with acute exacerbation, emphysema, cystic fibrosis exacerbation, or acute respiratory failure), objective oxygenation measurements, interventions provided (oxygen, bronchodilators, ventilatory support), and clinical decision-making by the treating clinician.

Coding Specifications

Modifier	Description	When to Use
`25`	Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure

Taxonomy Code	Specialty	Notes
`207RP1000X`	Pulmonary Disease	Pulmonologists manage COPD, emphysema, cystic fibrosis complications, and acute respiratory failure.

ICD-10 Code	Description	Clinical Relevance
`Data not available in the input.`	Data not available in the input.	Data not available in the input.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`94002`	Ventilation assist and management, initiation of pressure or volume preset ventilators for assisted or controlled breathing; hospital inpatient/observation, initial day	Performed when acute respiratory failure requires initiation of mechanical ventilation; used at the start of ventilator management.

94010 | Ventilator management, initial day, subsequent days, used to report daily management of mechanical ventilation | Used for ongoing daily management of a patient on mechanical ventilation for respiratory failure.

94640 | Pressurized or non-pressurized inhalation treatment for acute airway obstruction or for sputum induction for diagnostic purposes | Used for bronchodilator nebulization treatments given for acute COPD exacerbation or airway obstruction.

94620 | Continuous positive airway pressure ventilation (CPAP), initiation and management | Used when noninvasive positive pressure ventilation such as CPAP or BiPAP is initiated for acute respiratory failure due to COPD exacerbation.

94060 | Bronchospasm evaluation by spirometry including measurement of lung volumes and airway resistance, pre- and post-bronchodilator administration | Used in outpatient or inpatient settings to assess bronchodilator response in COPD/emphysema when clinically appropriate.

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