Question 1

What is HCPCS code M1184?

Accepted Answer

HCPCS code M1184 is "Doc med rsn no cst/ist rx". Documentation of medical reason(s) for not prescribing or administering corticosteroid or immunosuppressant treatment (e.g., allergy, intolerance, infectious etiology, pancreatic insufficiency, hyperthyroidism, prior bowel surgical interventions, celiac disease, receiving other medication, awaiting diagnostic workup results for alternative etiologies, other medical reasons/contraindication)

Question 2

What category is M1184 in?

Accepted Answer

M1184 belongs to HCPCS Category M (Medical Services).

Question 3

When should I use HCPCS code M1184?

Accepted Answer

Use M1184 when billing for doc med rsn no cst/ist rx. 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 M1184 covered by Medicare?

Accepted Answer

Coverage for M1184 (Doc med rsn no cst/ist rx) 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 M1184?

Accepted Answer

Documentation for M1184 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).