Question 1

What is HCPCS code M0237?

Accepted Answer

HCPCS code M0237 is "Intrav inf, toci, first dose". Intravenous infusion, tocilizumab-anoh, for hospitalized adult patients with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ecmo) only, includes infusion and post administration monitoring, first dose

Question 2

What category is M0237 in?

Accepted Answer

M0237 belongs to HCPCS Category M (Medical Services).

Question 3

When should I use HCPCS code M0237?

Accepted Answer

Use M0237 when billing for intrav inf, toci, first dose. HCPCS Level II codes like this are used for items and services not covered by CPT codes, including medical supplies, equipment, drugs administered in clinical settings, and certain healthcare services.

Question 4

Is M0237 covered by Medicare?

Accepted Answer

Coverage for M0237 (Intrav inf, toci, first dose) depends on medical necessity and specific Medicare guidelines. Check the applicable Local Coverage Determination (LCD) or National Coverage Determination (NCD) for detailed coverage criteria. Private insurers may have different coverage policies.

Question 5

What documentation is required for M0237?

Accepted Answer

Documentation for M0237 should include: the medical necessity for the item or service, supporting diagnosis codes (ICD-10), prescription or order from the treating physician, and proof that the item meets quality standards. Some items may require additional documentation like a Certificate of Medical Necessity (CMN).