Question 1

What is HCPCS code M1201?

Accepted Answer

HCPCS code M1201 is "Med rsn no ace-i/arb rx". Documentation of medical reason(s) for not prescribing ace inhibitor (ace-i) or arb therapy during the measurement period (e.g., pregnancy, history of angioedema to ace-i, other allergy to ace-i and arb, hyperkalemia or history of hyperkalemia while on ace-i or arb therapy, acute kidney injury due to ace-i or arb therapy), other medical reasons)

Question 2

What category is M1201 in?

Accepted Answer

M1201 belongs to HCPCS Category M (Medical Services).

Question 3

When should I use HCPCS code M1201?

Accepted Answer

Use M1201 when billing for med rsn no ace-i/arb rx. 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 M1201 covered by Medicare?

Accepted Answer

Coverage for M1201 (Med rsn no ace-i/arb rx) 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 M1201?

Accepted Answer

Documentation for M1201 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).