Question 1

What is HCPCS code M1065?

Accepted Answer

HCPCS code M1065 is "Shing vac no adm clinc rsn". Shingrix vaccine was not administered for reasons documented by clinician (e.g. patient administered vaccine other than shingrix, patient allergy or other medical reasons, patient declined or other patient reasons, vaccine not available or other system reasons)

Question 2

What category is M1065 in?

Accepted Answer

M1065 belongs to HCPCS Category M (Medical Services).

Question 3

When should I use HCPCS code M1065?

Accepted Answer

Use M1065 when billing for shing vac no adm clinc rsn. 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 M1065 covered by Medicare?

Accepted Answer

Coverage for M1065 (Shing vac no adm clinc rsn) 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 M1065?

Accepted Answer

Documentation for M1065 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).