HCPCS code M1008 – RA disease activity assessed at under 50% of encounters

Key takeaways

HCPCS code M1008 marks Performance Not Met on MIPS Quality ID #177 when RA disease activity was scored at under half of visits.

Its sibling codes are M1007, for scores at 50% or more of encounters, and M1006, for no assessment with no reason given.

Only a numeric score from an ACR-preferred tool, such as CDAI, DAS28, PAS-II, RAPID3 or SDAI, counts toward the 50% threshold.

The measure covers patients 18 and older with two or more RA encounters at least 90 days apart, and telehealth visits do not count.

In 2026, Measure 177 is collected as a MIPS CQM only, and M1008 carries no payment rate.

What is HCPCS code M1008?

HCPCS code M1008 is a quality data code for MIPS Quality ID #177 (CBE 2523), Rheumatoid Arthritis (RA): Periodic Assessment of Disease Activity.

Its official descriptor reads “<50% of total number of a patient’s outpatient RA encounters assessed,” and it is one of the measure’s three numerator codes.

M1008 counts as Performance Not Met. The clinician scored disease activity, but at fewer than half of the patient’s outpatient RA encounters in the performance period. The American College of Rheumatology (ACR) maintains the measure, and CMS runs it through the Quality Payment Program.

Measure 177 follows the ACR treat-to-target approach. Scoring disease activity at most visits helps clinicians steer treatment toward low disease activity or remission. That is why the threshold sits at half of a patient’s RA encounters.

What M1008 covers and what it excludes

M1008 covers one outcome: an eligible RA patient whose disease activity was scored, but not often enough to reach the 50% threshold.

When M1008 applies: The patient is 18 or older and has two or more RA encounters at least 90 days apart. Valid scores exist for some encounters, but they cover less than 50% of the patient’s outpatient RA encounters in the period.

When M1008 does not apply: Another code fits, or the patient is outside the measure population, in these cases.

• Scores at 50% or more of encounters: report M1007, Performance Met.
• No disease activity assessment and no documented reason: report M1006.
• Only one RA encounter, or two less than 90 days apart: the patient is outside the denominator.
• Telehealth visits: only in-person encounters count, so leave video visits out of the calculation.
• Patients under 18 on the date of the encounter: the measure does not apply.

M1008 and MIPS quality reporting for Measure 177

Measure 177 sits in the MIPS Quality performance category, and it appears in the rheumatology specialty set. For the 2026 performance period, CMS lists one collection type for it: the MIPS CQM.

The 2026 specification says its quality data codes “do not need to be submitted” under the MIPS CQM collection type. The codes still define the three numerator outcomes, so they are the clearest way to label each patient’s result.

Measure specifications change each year. Confirm the current version in the QPP quality measure explorer before the performance period starts.

How to report M1008

M1008 is assigned once per patient for the performance period, after every eligible encounter has been counted. Work through these steps for each RA patient in the measure population.

1. Confirm the denominator. The patient is 18 or older and has an RA diagnosis from the M05 or M06 codes the specification lists.
2. Check the 90-day spacing. Confirm a second RA encounter at least 90 days from one in the period, in this period or the prior one.
3. Count outpatient RA encounters. Include visits billed with the listed codes, such as 99202–99205 and 99212–99215, and leave out telehealth visits.
4. Count scored encounters. Count only visits where an ACR-preferred tool produced a numeric score within its valid range.
5. Work out the percentage. Divide scored encounters by total RA encounters. At least one score, but under 50%, points to M1008.
6. Submit once per patient. Send the result through your registry or QCDR. If a patient is submitted more than once, CMS uses the most advantageous code.

Take a patient with six in-person RA visits in 2026. A CDAI score was recorded at two of them, which is 33%, so the patient lands on M1008. One more scored visit brings the rate to 50% and moves the patient to M1007. The scenarios below show where each share lands.

A visit note that says only “moderate disease activity” adds nothing to the count. The specification excludes a level recorded without a calculated numeric score.

Documentation requirements for HCPCS code M1008

The record has to show both sides of the calculation: every eligible encounter and every valid score. An auditor should reach the same percentage from the chart alone.

The specification gives an example of an invalid entry: a CDAI of 101, when the tool’s maximum is 76.0. A score field with range limits in the RA visit note stops a typo like that from reaching the count. Good medical billing compliance habits make these records easier to defend.

Codes commonly confused with HCPCS code M1008

M1006, M1007 and M1008 share one measure and differ only in how often disease activity was scored. Two further M-codes in the same specification define the denominator, not the numerator.

The most common slip is M1006 in place of M1008. If even one valid score exists for the period, M1006 is wrong. The AAPC HCPCS code lookup shows the published descriptor for each code. Other Level II quality data codes are covered in our library of HCPCS codes.

Payer acceptance for HCPCS code M1008

M1008 exists for MIPS, and no payer reimburses it. CMS maintains it within HCPCS Level II as a quality data code with no payment rate. As a MIPS CQM, Measure 177 counts eligible patients from every payer, not only Medicare.

Keep the quality outcome off commercial claim lines. An unrecognized code there adds a rejection risk and earns no quality credit.

Common M1008 reporting errors and how to fix them

Errors with M1008 rarely show up as claim denials. They show up as a lower Measure 177 performance rate, or as a patient in the wrong numerator. The chart reviews behind good denial management catch both.

Review RA patients at mid-year, not only after the period closes. A patient at 33% in June can still reach 50% with scored visits before December.

How Pabau supports disease activity documentation for RA visits

Measure 177 points are usually lost in the visit note. A score gets described in words, or the tool name is missing, and the encounter no longer counts.

Pabau, the practice management and EMR platform we build, lets you add a CDAI or RAPID3 score field to the medical form for RA visits. Each note then holds the tool, the number and the date your registry submission depends on.

For the visits themselves, Pabau’s claims management software sends US claims through Claim.MD. It covers CMS-1500/837P claims, eligibility checks and ERA remittances. MIPS quality data still goes to CMS through your registry or QCDR.

Capture a disease activity score at every RA visit

Pabau’s medical forms record the tool and score in each RA visit note, and US claims for those visits run through Claim.MD.

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Conclusion

M1008 tells CMS that a patient’s RA disease activity was measured, just not often enough. That makes it the most recoverable outcome in Measure 177. The practice already uses a tool, so it only needs to use it at more visits.

Check each RA patient’s scored-visit rate before the year ends, and record a numeric score at every in-person visit. A patient moved from M1008 to M1007 lifts your performance rate without any change to billing.

Book a demo to see how Pabau keeps a disease activity score in every RA visit note.

Continue your research

Need a foundation for understanding how claims flow from encounter to payer? What is medical billing explains the end-to-end process including where quality data codes fit in the workflow.

Seeing recurring rejections on Medicare claims? Denial codes in medical billing breaks down the most common CARC codes and the corrective steps for each.

Reporting a patient who reached the 50% threshold? HCPCS code M1007 covers the Performance Met outcome for Measure 177.

Confirming the RA diagnosis behind the denominator? ICD-10 code M06.9 explains the code for rheumatoid arthritis, unspecified.

Want to understand the broader quality and compliance landscape for your practice? Medical billing compliance covers documentation standards, audit risk, and how to build compliant workflows.

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