Question 1

What is HCPCS code M1198?

Accepted Answer

HCPCS code M1198 is "Isa not red 3pts /no assess". Itch severity assessment score was not reduced by at least 3 points from initial (index) score to the follow-up visit score or assessment was not completed during the follow-up encounter

Question 2

What category is M1198 in?

Accepted Answer

M1198 belongs to HCPCS Category M (Medical Services).

Question 3

When should I use HCPCS code M1198?

Accepted Answer

Use M1198 when billing for isa not red 3pts /no assess. 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 M1198 covered by Medicare?

Accepted Answer

Coverage for M1198 (Isa not red 3pts /no assess) 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 M1198?

Accepted Answer

Documentation for M1198 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).