Question 1

What is HCPCS code M1192?

Accepted Answer

HCPCS code M1192 is "Pt w/ dx sq cell ca of esoph". Patients with an existing diagnosis of squamous cell carcinoma of the esophagus

Question 2

What category is M1192 in?

Accepted Answer

M1192 belongs to HCPCS Category M (Medical Services).

Question 3

When should I use HCPCS code M1192?

Accepted Answer

Use M1192 when billing for pt w/ dx sq cell ca of esoph. 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 M1192 covered by Medicare?

Accepted Answer

Coverage for M1192 (Pt w/ dx sq cell ca of esoph) 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 M1192?

Accepted Answer

Documentation for M1192 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).