Question 1

What is HCPCS code M1194?

Accepted Answer

HCPCS code M1194 is "Med rsn no imp/con mmr/msi". Documentation of medical reason(s) surgical pathology reports did not contain impression or conclusion of or recommendation for testing of mmr by immunohistochemistry, msi by dna-based testing status, or both tests were not included (e.g., patient will not be treated with checkpoint inhibitor therapy, no residual carcinoma is present in the sample [tissue exhausted or status post neoadjuvant treatment], insufficient tumor for testing)

Question 2

What category is M1194 in?

Accepted Answer

M1194 belongs to HCPCS Category M (Medical Services).

Question 3

When should I use HCPCS code M1194?

Accepted Answer

Use M1194 when billing for med rsn no imp/con mmr/msi. 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 M1194 covered by Medicare?

Accepted Answer

Coverage for M1194 (Med rsn no imp/con mmr/msi) 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 M1194?

Accepted Answer

Documentation for M1194 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).