M1321 Medicare Reimbursement Rate (2026)
Current CMS pricing and breakdown for Pts no 7wk inj,no iop,iop>25.
National Average Payment
A national base rate is not currently published.
Search the Full 2026 Fee Schedule
Don't rely on national estimates. Use our free Master Search Tool to find the exact rate for your specific Zip Code or browse 18,000+ other billing codes.
Historical Medicare Reimbursement
| Quarter | Non-Facility Rate | Facility Rate | YoY % Change (Non-Fac) | YoY % Change (Fac) |
|---|---|---|---|---|
| 2026 Q3 | $0.00 | $0.00 | — | — |
| 2026 Q2 | $0.00 | $0.00 | — | — |
| 2026 Q1 | $0.00 | $0.00 | — | — |
| 2025 Q4 | $0.00 | $0.00 | — | — |
| 2025 Q3 | $0.00 | $0.00 | — | — |
| 2025 Q2 | $0.00 | $0.00 | — | — |
| 2025 Q1 | $0.00 | $0.00 | — | — |
Code Description
Patients who were not seen within 7 weeks following the date of injection for follow up or who did not have a documented iop or no plan of care documented if the iop was >25 mm hg
Reimbursement Summary
CPT code M1321 (Patients who were not seen within 7 weeks following the date of injection for follow up or who did not have a documented iop or no plan of care documented if the iop was >25 mm hg) does not currently have a published national facility or non-facility reimbursement rate in 2026.
M1321 is a HCPCS Level II code in the category “Physician Service.” Medicare does not publish a single national payment amount for this code in 2026 (No National Rate). A national base rate is not currently published.
To estimate a local payment amount when available, use MedFeeSchedule's Medicare Physician Fee Schedule Lookup Tool on the homepage and confirm final pricing guidance through CMS or your local Medicare Administrative Contractor (MAC).
Q3 2026 Breakdown
| Component | Office (Non-Fac) | Facility (Hosp) |
|---|---|---|
| Work RVU | 0 | 0 |
| Practice Expense (PE) | 0 | 0 |
| Malpractice (MP) | 0 | 0 |
| Total RVUs | 0.00 | 0.00 |
Are you being paid correctly for this code?
Compare a payment against the Medicare benchmark for this code.
Medicare rates are used as a benchmark only. Actual payer contracts, modifiers, place of service, units, and billing rules may affect reimbursement. This tool is for educational and operational review purposes, not legal or billing advice.
Facility vs. Non-Facility (Office) Payment
Medicare often publishes two payment rates for the same code: a **non-facility** rate (typically used when the service is performed in a private office where the clinician bears more overhead) and a **facility** rate (typically used when performed in a hospital or facility where the facility bills separately for its costs).
Because the practice expense portion of RVUs differs by setting, the non-facility and facility payment amounts can be different. For locality-adjusted estimates in 2026, use MedFeeSchedule's Medicare Physician Fee Schedule Lookup Tool.
Learn How This Reimbursement Is Calculated
Medicare reimbursement is determined by RVUs, geographic adjustments, and the annual conversion factor.
Frequently Asked Questions
What is the 2026 Medicare rate for M1321?
Medicare does not publish a single national reimbursement rate for M1321 in 2026 (No National Rate). Use MedFeeSchedule's Medicare Physician Fee Schedule Lookup Tool to explore locality-adjusted estimates when applicable.
What is the description for code M1321?
Patients who were not seen within 7 weeks following the date of injection for follow up or who did not have a documented iop or no plan of care documented if the iop was >25 mm hg
Why do facility and non-facility payments differ for M1321?
For many physician services, Medicare publishes different practice-expense RVUs by setting. In general, non-facility rates apply when services are performed in a private office, while facility rates apply when performed in a hospital or facility where the facility bills separately.
How can I find my local Medicare rate for M1321?
Use MedFeeSchedule's Medicare Physician Fee Schedule Lookup Tool on the homepage to estimate your locality-adjusted reimbursement. Medicare payment can vary based on geographic adjustments (GPCI), place of service, and claim specifics.
Is M1321 covered by Medicare?
Coverage depends on medical necessity, setting, and Medicare policy. Some codes may be bundled, contractor-priced, or restricted. Verify final coverage guidance through CMS or your local MAC when applicable.
