Question 1

What is HCPCS code M1146?

Accepted Answer

HCPCS code M1146 is "Ongoing care not ind". Ongoing care not clinically indicated because the patient needed a home program only, referral to another provider or facility, or consultation only, as documented in the medical record

Question 2

What category is M1146 in?

Accepted Answer

M1146 belongs to HCPCS Category M (Medical Services).

Question 3

When should I use HCPCS code M1146?

Accepted Answer

Use M1146 when billing for ongoing care not ind. 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 M1146 covered by Medicare?

Accepted Answer

Coverage for M1146 (Ongoing care not ind) 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 M1146?

Accepted Answer

Documentation for M1146 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).