Question 1

What is HCPCS code M1173?

Accepted Answer

HCPCS code M1173 is "Pt no rec td/tdap 9yrs prior". Patient did not receive at least one td vaccine or one tdap vaccine between nine years prior to the encounter and the end of the measurement period

Question 2

What category is M1173 in?

Accepted Answer

M1173 belongs to HCPCS Category M (Medical Services).

Question 3

When should I use HCPCS code M1173?

Accepted Answer

Use M1173 when billing for pt no rec td/tdap 9yrs prior. 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 M1173 covered by Medicare?

Accepted Answer

Coverage for M1173 (Pt no rec td/tdap 9yrs prior) 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 M1173?

Accepted Answer

Documentation for M1173 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).