Question 1

What is HCPCS code M1152?

Accepted Answer

HCPCS code M1152 is "Pt w/ hx trnsplt or lvad". Patients with a history of heart transplant or with a left ventricular assist device (lvad)

Question 2

What category is M1152 in?

Accepted Answer

M1152 belongs to HCPCS Category M (Medical Services).

Question 3

When should I use HCPCS code M1152?

Accepted Answer

Use M1152 when billing for pt w/ hx trnsplt or lvad. 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 M1152 covered by Medicare?

Accepted Answer

Coverage for M1152 (Pt w/ hx trnsplt or lvad) 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 M1152?

Accepted Answer

Documentation for M1152 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).