Question 1

What is HCPCS code M1177?

Accepted Answer

HCPCS code M1177 is "Pt recd pcv on/aft 19". Patient received any pneumococcal conjugate or polysaccharide vaccine on or after their 19th birthday and before the end of the measurement period

Question 2

What category is M1177 in?

Accepted Answer

M1177 belongs to HCPCS Category M (Medical Services).

Question 3

When should I use HCPCS code M1177?

Accepted Answer

Use M1177 when billing for pt recd pcv on/aft 19. 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 M1177 covered by Medicare?

Accepted Answer

Coverage for M1177 (Pt recd pcv on/aft 19) 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 M1177?

Accepted Answer

Documentation for M1177 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).