Question 1

What is HCPCS code M1170?

Accepted Answer

HCPCS code M1170 is "Pt w/o flu vax 7/1-6/30". Patient did not receive an influenza vaccine on or between july 1 of the year prior to the measurement period and june 30 of the measurement period

Question 2

What category is M1170 in?

Accepted Answer

M1170 belongs to HCPCS Category M (Medical Services).

Question 3

When should I use HCPCS code M1170?

Accepted Answer

Use M1170 when billing for pt w/o flu vax 7/1-6/30. 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 M1170 covered by Medicare?

Accepted Answer

Coverage for M1170 (Pt w/o flu vax 7/1-6/30) 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 M1170?

Accepted Answer

Documentation for M1170 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).