Question 1

What is HCPCS code M1164?

Accepted Answer

HCPCS code M1164 is "Pt w/ dementia any time". Patients with dementia any time during the patient's history through the end of the measurement period

Question 2

What category is M1164 in?

Accepted Answer

M1164 belongs to HCPCS Category M (Medical Services).

Question 3

When should I use HCPCS code M1164?

Accepted Answer

Use M1164 when billing for pt w/ dementia any time. 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 M1164 covered by Medicare?

Accepted Answer

Coverage for M1164 (Pt w/ dementia any time) 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 M1164?

Accepted Answer

Documentation for M1164 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).