Question 1

What is HCPCS code M1189?

Accepted Answer

HCPCS code M1189 is "Doc khe pef w/efgr/uacr". Documentation of a kidney health evaluation defined by an estimated glomerular filtration rate (egfr) and urine albumin-creatinine ratio (uacr) performed

Question 2

What category is M1189 in?

Accepted Answer

M1189 belongs to HCPCS Category M (Medical Services).

Question 3

When should I use HCPCS code M1189?

Accepted Answer

Use M1189 when billing for doc khe pef w/efgr/uacr. 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 M1189 covered by Medicare?

Accepted Answer

Coverage for M1189 (Doc khe pef w/efgr/uacr) 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 M1189?

Accepted Answer

Documentation for M1189 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).