Question 1

What is HCPCS code M1035?

Accepted Answer

HCPCS code M1035 is "Adt pd out mat pr 180 dys tx". Adults who are deliberately phased out of medication assisted treatment (mat) prior to 180 days of continuous treatment

Question 2

What category is M1035 in?

Accepted Answer

M1035 belongs to HCPCS Category M (Medical Services).

Question 3

When should I use HCPCS code M1035?

Accepted Answer

Use M1035 when billing for adt pd out mat pr 180 dys tx. 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 M1035 covered by Medicare?

Accepted Answer

Coverage for M1035 (Adt pd out mat pr 180 dys tx) 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 M1035?

Accepted Answer

Documentation for M1035 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).