Question 1

What is HCPCS code M1197?

Accepted Answer

HCPCS code M1197 is "Isa reduced >=3 fr ixv". Itch severity assessment score is reduced by 3 or more points from the initial (index) assessment score to the follow-up visit score

Question 2

What category is M1197 in?

Accepted Answer

M1197 belongs to HCPCS Category M (Medical Services).

Question 3

When should I use HCPCS code M1197?

Accepted Answer

Use M1197 when billing for isa reduced >=3 fr ixv. 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 M1197 covered by Medicare?

Accepted Answer

Coverage for M1197 (Isa reduced >=3 fr ixv) 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 M1197?

Accepted Answer

Documentation for M1197 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).