Question 1

What is HCPCS code M1166?

Accepted Answer

HCPCS code M1166 is "Path rpt tis spec wle/reexc". Pathology report for tissue specimens produced from wide local excisions or re-excisions

Question 2

What category is M1166 in?

Accepted Answer

M1166 belongs to HCPCS Category M (Medical Services).

Question 3

When should I use HCPCS code M1166?

Accepted Answer

Use M1166 when billing for path rpt tis spec wle/reexc. 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 M1166 covered by Medicare?

Accepted Answer

Coverage for M1166 (Path rpt tis spec wle/reexc) 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 M1166?

Accepted Answer

Documentation for M1166 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).