Question 1

What is HCPCS code M1028?

Accepted Answer

HCPCS code M1028 is "Doc of pt prm hda dx and otr". Documentation of patients with primary headache diagnosis and imaging other than ct or mri obtained

Question 2

What category is M1028 in?

Accepted Answer

M1028 belongs to HCPCS Category M (Medical Services).

Question 3

When should I use HCPCS code M1028?

Accepted Answer

Use M1028 when billing for doc of pt prm hda dx and otr. 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 M1028 covered by Medicare?

Accepted Answer

Coverage for M1028 (Doc of pt prm hda dx and otr) 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 M1028?

Accepted Answer

Documentation for M1028 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).