Question 1

What is HCPCS code M1186?

Accepted Answer

HCPCS code M1186 is "Pt w/ rx for hspc/plltv care". Patients who have an order for or are receiving hospice or palliative care

Question 2

What category is M1186 in?

Accepted Answer

M1186 belongs to HCPCS Category M (Medical Services).

Question 3

When should I use HCPCS code M1186?

Accepted Answer

Use M1186 when billing for pt w/ rx for hspc/plltv care. 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 M1186 covered by Medicare?

Accepted Answer

Coverage for M1186 (Pt w/ rx for hspc/plltv care) 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 M1186?

Accepted Answer

Documentation for M1186 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).