Question 1

What is HCPCS code M1003?

Accepted Answer

HCPCS code M1003 is "Tb scr 12 mo pri fst bio dz". Tb screening performed and results interpreted within twelve months prior to initiation of first-time biologic and/or immune response modifier therapy

Question 2

What category is M1003 in?

Accepted Answer

M1003 belongs to HCPCS Category M (Medical Services).

Question 3

When should I use HCPCS code M1003?

Accepted Answer

Use M1003 when billing for tb scr 12 mo pri fst bio dz. 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 M1003 covered by Medicare?

Accepted Answer

Coverage for M1003 (Tb scr 12 mo pri fst bio dz) 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 M1003?

Accepted Answer

Documentation for M1003 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).