Question 1

What is HCPCS code M1004?

Accepted Answer

HCPCS code M1004 is "Doc med rsn no srn tb". Documentation of medical reason for not screening for tb or interpreting results (i.e., patient positive for tb and documentation of past treatment; patient who has recently completed a course of anti-tb therapy)

Question 2

What category is M1004 in?

Accepted Answer

M1004 belongs to HCPCS Category M (Medical Services).

Question 3

When should I use HCPCS code M1004?

Accepted Answer

Use M1004 when billing for doc med rsn no srn tb. 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 M1004 covered by Medicare?

Accepted Answer

Coverage for M1004 (Doc med rsn no srn tb) 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 M1004?

Accepted Answer

Documentation for M1004 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).