Question 1

What is HCPCS code M1175?

Accepted Answer

HCPCS code M1175 is "Doc med rsn no hzv". Documentation of medical reason(s) for not administering zoster vaccine (e.g., prior anaphylaxis due to the zoster vaccine)

Question 2

What category is M1175 in?

Accepted Answer

M1175 belongs to HCPCS Category M (Medical Services).

Question 3

When should I use HCPCS code M1175?

Accepted Answer

Use M1175 when billing for doc med rsn no hzv. 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 M1175 covered by Medicare?

Accepted Answer

Coverage for M1175 (Doc med rsn no hzv) 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 M1175?

Accepted Answer

Documentation for M1175 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).