HCPCS code M1003 – TB screening before biologics

Key takeaways

HCPCS Code M1003 reports that TB screening was performed and the results interpreted within 12 months before a first course of biologic therapy.

M1003 is the Performance Met code for MIPS Quality ID #176, with M1004 for a medical exception and M1005 for screening not done.

The measure counts patients aged 18 and older starting a first-time biologic or immune response modifier, identified by G2182.

M1003 carries no Medicare payment, but each case it reports raises the clinician’s measure #176 performance rate.

The chart must show the test type, the test date, the result and the clinician’s interpretation, all before the biologic prescription.

HCPCS Code M1003: Official descriptor and code classification

HCPCS Code M1003 is a quality data code, not a billable service. It tells CMS that a patient starting a first course of biologic therapy was screened for tuberculosis (TB) beforehand. The screening counts only if a clinician interpreted the result within the 12 months before therapy began.

The Centers for Medicare and Medicaid Services (CMS) maintains M1003 in the HCPCS Level II M-code series. The figures below come from the October 2026 alpha-numeric file in the CMS HCPCS release.

M1003 sits in the M1000 block of quality data codes, and its two siblings follow it directly. M1004 reports a documented medical reason for skipping the screening. M1005 reports a screening that was not done, with no reason given.

What HCPCS Code M1003 covers and what it excludes

M1003 belongs to one measure and one clinical moment. Quality ID #176 asks whether a patient was tested for TB before starting a biologic that carries a warning about reactivating latent infection.

Agents such as TNF inhibitors and Janus kinase (JAK) inhibitors can wake a dormant TB infection. Screening first lets the clinician treat latent TB before the immune system is suppressed.

The 2026 measure specification defines who counts and what qualifies.

• Patient age: 18 years or older on the date of the encounter.
• First course only: the patient is prescribed a biologic or immune response modifier during the performance period. No such prescription can appear in the 15 months before it.
• Qualifying encounter: an office, home or telehealth visit code from the measure list, such as 99202-99205 or 99212-99215.
• Therapy flag: G2182 identifies a patient receiving first-time biologic and/or immune response modifier therapy.
• Qualifying tests: a tuberculin skin test (TST, also called PPD), an interferon-gamma release assay (IGRA), or another appropriate method.
• Timing: the test is documented in the 12 months before the biologic prescription, and its result is interpreted.

The agent list in the specification covers drugs such as adalimumab, etanercept, infliximab, ustekinumab, secukinumab, tofacitinib and upadacitinib. CMS notes that newly approved agents requiring TB testing also qualify, even before the list is updated.

M1003 does not apply in these cases.

• A patient continuing a biologic they already took within the 15-month lookback. That patient is outside the denominator.
• A test that was ordered but never resulted or interpreted. That case is M1005.
• A patient with documented past TB treatment, or a recently completed anti-TB course. That case is M1004.
• A test performed more than 12 months before the biologic prescription.
• Any other quality measure. M1003 reports measure #176 only.

Documentation requirements for reporting M1003

Auditors judge M1003 by what the chart shows. Someone reading the record should find the screening, its result and the interpretation without asking anyone.

• Test type: name the test as a TST, an IGRA such as QuantiFERON-TB Gold Plus or T-SPOT.TB, or another method.
• Test date: record the date the test was performed, which must fall within 12 months before the biologic prescription.
• Result: record the induration in millimeters for a TST, or the positive, negative or indeterminate result for an IGRA.
• Interpretation: the clinician states what the result means for this patient. A pasted lab value alone does not show interpretation.
• Follow-up for positives: a positive screen still counts as M1003 once interpreted. Document the chest imaging and latent TB treatment plan that follows.
• Prescription date: the biologic prescription date anchors the 12-month window, so it must be clear in the record.

An outside result counts if it is in the record and interpreted. A patient screened by a dermatologist eight months earlier does not need a second test from the rheumatologist. The rheumatologist still documents the result and their interpretation.

ICD-10 diagnosis codes paired with M1003

Measure #176 has no diagnosis criteria in its denominator, so no ICD-10-CM code switches M1003 on or off. The diagnoses on the claim still support the encounter and explain why a biologic was started. The codes below are common examples, verified against the FY2026 ICD-10-CM code set.

Code the underlying condition to the highest specificity the note supports. The unspecified codes above are starting points, not defaults.

M1003 vs M1004 and M1005: Choosing the right code

Every denominator-eligible case gets exactly one of the three codes. The table shows what separates them.

The decision rule is short. Screened and interpreted inside the window is M1003. A documented TB treatment history is M1004. Everything else, including a refused test, is M1005.

Take a psoriasis patient with a negative QuantiFERON from four months ago. The dermatologist notes the negative result and starts risankizumab. That encounter is M1003, with L40.0 as the supporting diagnosis.

How Quality ID #176 scores M1003

For 2026, CMS offers measure #176 only through the MIPS clinical quality measure (CQM) collection type. That usually means reporting through a registry or a qualified clinical data registry (QCDR). It is not a Medicare Part B claims measure.

The 2026 specification says CQM submitters do not have to send the quality data codes at all. Registries may still read M1003 from claims when they build the measure from Medicare Part B claims data. Ask your registry which route it uses before you add the code to claims.

• Numerator: M1003 cases.
• Denominator: every eligible first-course patient, minus M1004 exceptions.
• Performance rate: M1003 cases divided by the denominator after exceptions.
• Reporting frequency: at least once per patient per performance period. CMS uses the most advantageous code if more than one is sent.

Take a practice with 40 first-course patients in 2026. Two have documented past TB treatment and are reported with M1004. If 34 of the other 38 are M1003, the rate is about 89%, and the chart below shows where each case lands.

The quality category carries 30% of the 2026 MIPS final score. Performance in 2026 sets the payment adjustment applied to Medicare Part B claims in 2028. Check the current measure details in the QPP Explore Measures tool before each performance year.

Medicare and payer coverage for HCPCS Code M1003

M1003 has no fee schedule amount. The HCPCS file gives it pricing indicator 00, so Part B never prices it separately. The payable work sits on other lines.

• The visit: the E/M code for the encounter where the biologic is started or the result reviewed.
• The test: 86580 for a tuberculin skin test, or 86480 or 86481 for an IGRA, billed by whoever performs it.
• The quality line: M1003 itself, at a $0.00 charge when your registry reads claims data. CMS allows $0.01 where a billing system rejects a zero charge.

Medicare typically denies a quality data code line with remark code N620, which marks it as informational. That denial is expected and needs no appeal. Commercial payers vary, and some reject M-codes outright, so strip the line where a payer does not accept it.

Common M1003 reporting errors and how to fix them

Most M1003 problems start in the chart before anyone builds the claim. The table lists the errors that undercount or overstate the measure.

The denial codes in medical billing guide covers how to read CARC and RARC codes on a remittance. The medical billing compliance guide explains how quality reporting interacts with audits.

How Pabau supports accurate M1003 reporting

Reporting M1003 correctly is mostly a record-keeping job. The clinician already made the decision. What remains is getting the test, the interpretation and the code into one place.

Pabau, the practice management and billing platform we build, assembles the claim from the patient record rather than a separate billing form. Encounter details and treatment notes pre-fill the claim, so the billing team does not retype what the clinician wrote.

A built-in code lookup sits beside the claim, so whoever is coding can add M1003 on its own line. Required-field checks flag an incomplete claim before Pabau’s claims management software sends it to your clearinghouse.

Those checks confirm the claim is complete. Whether the note supports M1003 is still a judgment for your clinician or compliance lead.

Keep quality codes beside the encounter they report

Pabau pre-fills claims from the patient record and checks required fields before submission. Your team adds codes like M1003 without retyping the visit.

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Conclusion

M1003 answers one question: was this patient screened for TB before their first biologic? The answer only counts when the chart shows the test, the date, the result and the clinician’s reading of it.

Treat the interpretation line as the step that earns the code. Practices that make it a habit at the prescribing visit rarely lose a screened patient from the measure #176 numerator.

Pabau keeps the code, the encounter and the note in one record. Book a demo to see how that fits your billing workflow.

Continue your research

Coding a documented TB history instead? M1004 covers the medical-reason exception for measure #176.

Screening never happened? M1005 explains the Performance Not Met code and how it lowers the rate.

Reporting rheumatoid arthritis measures too? M1006 covers disease activity not assessed under Quality ID #177.

Want fewer rejected claim lines? Clean claim standards explains what gets a claim through initial payer edits.

Frequently asked questions