Summary & Overview
HCPCS Level II M1469: Hepatitis B History or Positive Hepatitis B Test
HCPCS Level II code M1469 documents a patient’s history of hepatitis B illness or a prior positive laboratory test for hepatitis B surface antigen, hepatitis B surface antibody, or total antibody to hepatitis B core antigen. This designation is important for medical records, quality measurement, public health surveillance, and appropriate clinical decision-making related to vaccination, infection control, and care coordination. Nationally, consistent use of this code supports population-level tracking of hepatitis B exposure and immunity status and helps satisfy measure specifications in preventive and chronic care programs.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the code’s clinical meaning and typical sites of service, benchmarks and coverage context where available, and policy and documentation considerations tied to laboratory-confirmed or historical hepatitis B status. The summary highlights how M1469 is used in charting and reporting workflows and what types of clinical encounters commonly generate the code. Data not available in the input will be noted explicitly in detailed sections.
Billing Code Overview
HCPCS Level II code M1469 indicates a patient has a history of hepatitis B illness or has received testing showing a positive result for hepatitis B surface antigen, hepatitis B surface antibody, or total antibody to hepatitis B core antigen at any time before or during the measurement period. This status documents past or current evidence of hepatitis B infection or immunity based on laboratory results.
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Service type: Laboratory result documentation / disease history coding
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Typical site of service: Outpatient clinics, primary care offices, public health clinics, laboratory reporting systems, and other ambulatory care settings where hepatitis B testing and result documentation occur.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 48-year-old male presents to a primary care clinic with a documented history of prior hepatitis B infection identified during a previous hospitalization five years earlier. The clinician reviews the electronic medical record and notes prior laboratory results demonstrating a positive hepatitis B surface antigen (HBsAg) and positive total antibody to hepatitis B core antigen. During the current visit the clinician confirms the serologic history, updates the problem list, and documents counseling regarding hepatic surveillance and immunization status.
Typical clinical workflow: the patient chart is flagged by clinical staff for a history of hepatitis B (billing code M1469), the provider verifies prior positive serology and documents it in the encounter note, orders appropriate follow-up (for example, liver function tests or referral to hepatology if indicated), and the medical coder assigns M1469 to indicate the presence of prior or current positive hepatitis B serology for reporting and care management purposes. Typical site of service is an outpatient clinic, primary care office, or community health center where chronic disease management and preventive care documentation occurs.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 |