HCPCS code M1007 – Rheumatoid arthritis reporting

Key takeaways

M1007 is the Performance Met quality data code for MIPS Quality ID #177, which tracks periodic assessment of RA disease activity.

Report it when disease activity was scored with an ACR-preferred tool at ≥50% of the patient’s outpatient RA encounters in the performance period.

M1006 and M1008 are the two Performance Not Met codes, covering no assessment and assessment at fewer than half of encounters.

Telehealth visits leave the denominator, and a disease activity level recorded without a numerical score does not count toward the threshold.

M1007 is usually reported at a $0.00 charge with no standalone payment, but it feeds the MIPS score behind the payment adjustment.

HCPCS code M1007: Official descriptor and code details

HCPCS code M1007 is a Level II quality data code (QDC) used in the Merit-based Incentive Payment System (MIPS). It reports one outcome of Quality ID #177, Rheumatoid Arthritis (RA): Periodic Assessment of Disease Activity. The table below sets out the official wording and the measure details coders need.

Check the measure’s status on the Quality Payment Program measures page before each performance year. CMS revises measure specifications every year and can retire a measure through the annual Physician Fee Schedule rule. The code itself appears in the CMS HCPCS Level II data files. To compare M1007 with the neighboring M-codes, use our searchable HCPCS code library.

What M1007 measures

M1007 confirms that the clinician assessed RA disease activity with a standardized tool at half or more of a patient’s outpatient RA visits. The measure asks whether a practice scores disease activity systematically at each visit, rather than by impression.

The 2026 specification names five ACR-preferred tools:

• Clinical Disease Activity Index (CDAI)
• Disease Activity Score with 28-joint counts (DAS28), using ESR or CRP
• Patient Activity Score-II (PAS-II)
• Routine Assessment of Patient Index Data with 3 measures (RAPID3)
• Simplified Disease Activity Index (SDAI)

Two details decide whether a visit counts toward the 50%. The score must fall within the tool’s valid range, so a CDAI of 101 does not count when the maximum is 76. A disease activity level such as low or high, recorded without a numerical score, does not count either.

How the 50% threshold works

The threshold is calculated per patient across the whole performance period. A patient seen for RA at four in-person visits needs a valid score at two or more of them for M1007. One scored visit out of four makes the case M1008. No scored visits makes it M1006.

Who reports M1007

MIPS eligible clinicians who manage RA report M1007, and most of them are rheumatologists. Primary care physicians, internists and other clinicians who manage a patient’s RA can report the measure too.

A patient enters the denominator only when all of these apply:

• The patient is 18 or older on the date of the encounter.
• The chart carries an RA diagnosis from the measure’s ICD-10-CM list, which covers the M05 codes and most M06 codes.
• A qualifying encounter falls in the performance period: 99202–99205, 99212–99215, 99341, 99342, 99344, 99345, 99347–99350, 99424, 99426, G0402 or G0468.
• A second encounter with an RA diagnosis took place at least 90 days before or after it, in the current or prior performance period.
• The encounter took place in person, because telehealth encounters are removed.

Not every M06 code qualifies. Adult-onset Still’s disease (M06.1) and inflammatory polyarthropathy (M06.4) are absent from the 2026 list, so those patients never enter the denominator.

How to report HCPCS code M1007

M1007 is a numerator code, so it travels with the encounter that puts the patient in the denominator. No paired procedure sits behind it. The denominator comes from the E/M or listed HCPCS encounter code plus a qualifying RA diagnosis.

Collection type in 2026

In 2026, Quality ID #177 is collected as a MIPS CQM, usually through a registry or another third-party intermediary. The specification says clinicians using that collection type do not need to submit the quality data codes. Intermediaries that build their data from Medicare Part B claims may still use them, so your registry may ask for M1007 on the claim.

Claim mechanics when M1007 goes on the claim

• Same claim: Put M1007 on its own service line, on the same claim as the qualifying encounter.
• Diagnosis pointer: Point the M1007 line to the RA diagnosis code on that claim.
• Charge: Enter a $0.00 line-item charge. If your billing system rejects zero-dollar lines, CMS allows a nominal amount such as $0.01.
• Frequency: Report the measure at least once per patient per performance period. If more than one numerator code is reported, CMS uses the most advantageous one.
• Telehealth: Do not report M1007 from a telehealth visit, because that encounter does not count toward the measure.

M1007 generates no payment on its own. The Quality ID #177 performance rate feeds the MIPS quality category score. That score drives the payment adjustment applied to Medicare Part B payments two years later.

Documentation requirements for M1007

The chart must show a numerical disease activity score at each visit counted toward the threshold. A note that says RA is well controlled does not support M1007.

• Tool: Name the ACR-preferred tool used at the visit, such as CDAI, DAS28-ESR, DAS28-CRP, PAS-II, RAPID3 or SDAI.
• Score: Record the calculated numerical score, within the tool’s valid range. A category alone does not count.
• Encounter date: Record the date of each scored visit, so it can be matched to an in-person RA encounter in the performance period.
• RA diagnosis: Document a qualifying M05 or M06 code at two encounters at least 90 days apart.
• Encounter count: Keep enough detail to show that scored visits make up 50% or more of the patient’s outpatient RA encounters.

Store the score in a structured field rather than in free text. A registry or auditor can then count scored visits per patient without re-reading every note.

Common M1007 reporting errors and denial causes

Because M1007 carries a $0.00 charge, an error rarely shows up as a lost payment. It shows up as a lost or mis-scored quality case. Strong denial management in healthcare starts with knowing which of these responses needs action.

• Counting telehealth visits: Telehealth encounters leave the denominator, so including them in the 50% count can produce the wrong numerator code.
• Activity level without a score: A note reading moderate disease activity, with no number, does not count toward the threshold.
• Out-of-range scores: A score above the tool’s maximum points to a calculation error and is excluded.
• Non-qualifying diagnosis: Coding M06.1 or M06.4 alone leaves the patient outside the denominator, so the M1007 line has no effect.
• Missing second RA encounter: Without a second RA-diagnosis encounter at least 90 days apart, the patient does not meet the denominator.
• Reporting too early: A patient scored at the first visit but not at the next three ends the year below 50%. Confirm the count before the final submission.
• Misreading the remark code: A $0.00 quality data code line returns remark code N620, ‘This procedure code is for quality reporting/informational purposes only.’ It confirms the code was received for reporting, so do not appeal it.

M1007 vs M1006 and M1008: Choosing the right code

All three codes report the numerator of Quality ID #177, and each patient gets one outcome per performance period. The choice depends on how many in-person RA encounters carried a valid score.

The 2026 specification lists no denominator exception for this measure, so a missed assessment cannot be excused with a medical or patient reason. Check the current descriptors on the QPP measures page each year.

Pre-submission checklist for M1007

Run these checks before a registry submission, or before M1007 goes on a claim. Submitting a clean claim also protects the encounter line that M1007 travels with.

1. Confirm the patient is 18 or older and carries a qualifying M05 or M06 diagnosis.
2. Confirm two RA-diagnosis encounters at least 90 days apart.
3. Count the patient’s in-person RA encounters for the performance period, leaving out telehealth visits.
4. Count the encounters with a valid numerical score from an ACR-preferred tool.
5. Choose M1007 only if scored encounters reach 50% or more. Otherwise use M1008 or M1006.
6. If M1007 goes on a claim, give it its own line, a $0.00 charge and an RA diagnosis pointer.
7. Check that Quality ID #177 is still active for the performance year.

How Pabau supports accurate M1007 reporting

Most M1007 errors start in the chart. A score recorded in free text, or a visit logged as telehealth by mistake, changes the patient’s outcome at year end.

Pabau, the practice management and EHR platform we build, lets a practice add structured CDAI or RAPID3 score fields to its visit notes. Each score is stored against the encounter date, so your team can count scored visits per patient before reporting.

When M1007 goes on a claim, your coder adds it to the encounter. Pabau’s claims management software then submits the claim and tracks its status. That keeps the quality line visible alongside the rest of your medical billing work.

Keep RA disease activity scores report-ready

Pabau stores structured disease activity scores against each visit and submits your claims, so your team can confirm M1007 before reporting.

Book a demo

Conclusion

M1007 is decided in the exam room. The code is earned when the clinician records a numerical score from an ACR-preferred tool. It is lost when that score is missing, out of range or tied to a telehealth visit.

Build the score into every in-person RA visit, count scored encounters before submission, and recheck the measure’s status each year. Book a demo to see how Pabau keeps RA disease activity scores structured and ready for quality reporting.

Continue your research

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