Question 1

What is HCPCS code M1138?

Accepted Answer

HCPCS code M1138 is "Oc ni pt 1-2 vis". Ongoing care not indicated, patient seen only 1-2 visits (e.g., home program only, referred to another provider or facility, consultation only)

Question 2

What category is M1138 in?

Accepted Answer

M1138 belongs to HCPCS Category M (Medical Services).

Question 3

When should I use HCPCS code M1138?

Accepted Answer

Use M1138 when billing for oc ni pt 1-2 vis. 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 M1138 covered by Medicare?

Accepted Answer

Coverage for M1138 (Oc ni pt 1-2 vis) 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 M1138?

Accepted Answer

Documentation for M1138 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).