Summary & Overview
HCPCS Level II M1499: Interventional Radiology MIPS Value Pathway
HCPCS Level II code M1499 designates the interventional radiology MIPS value pathway, reflecting services tied to performance reporting and quality measurement in interventional radiology. The code matters nationally as health systems and providers increasingly participate in value-based programs that link clinical performance, quality metrics, and reimbursement adjustments. Accurately identifying services tied to this pathway supports compliance with MIPS reporting, aids payer negotiations, and informs operational planning for interventional radiology programs.
Key payers covered 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 scope and service settings, an outline of which payers are relevant to national benchmarking, and guidance on where to find additional documentation and policy resources. The publication highlights the clinical context of interventional radiology procedures within value-based reporting frameworks, expected sites of service, and the potential implications for provider workflows and billing processes. Sections provide benchmarks, relevant policy updates, and links to payer resources when available. Data not available in the input are noted where applicable.
Billing Code Overview
HCPCS Level II code M1499 is defined as Interventional radiology mips value pathway. This code represents services associated with interventional radiology under the Merit-based Incentive Payment System (MIPS) value pathway framework.
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Service type: Interventional radiology procedures and associated services focused on value-based performance reporting
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Typical site of service: Hospital outpatient departments, ambulatory surgical centers, and interventional radiology suites
Data not available in the input for payers, common modifiers, associated taxonomies, ICD-10 diagnoses, related codes, and service line.
Clinical & Coding Specifications
Clinical Context
A typical patient is a 68-year-old male with symptomatic peripheral arterial disease presenting with lifestyle-limiting claudication and non-healing ischemic foot ulcers despite conservative therapy. After noninvasive vascular testing (ABI, arterial duplex) and shared decision-making, the patient is referred for image-guided endovascular intervention by an interventional radiologist. On the day of service the patient is evaluated in the outpatient interventional suite, informed consent is obtained, intravenous access is secured, moderate sedation is administered by the procedural team, and vascular access (commonly common femoral artery) is obtained under ultrasound guidance. Diagnostic angiography of the affected limb is performed to map lesions; lesion crossing, angioplasty with or without stent placement, atherectomy, and embolization of occlusive thrombus or treatment of critical stenosis are performed as indicated. Hemostasis is achieved with manual compression or closure device, and post-procedure monitoring occurs in the recovery area with discharge instructions and outpatient follow-up arranged.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When only the physician professional portion of a service is billed and the technical component is billed separately |
TC |