Question 1

What is HCPCS code M1202?

Accepted Answer

HCPCS code M1202 is "Pt rsn no ace-i/arb rx". Documentation of patient reason(s) for not prescribing ace inhibitor or arb therapy during the measurement period, (e.g., patient declined, other patient reasons)

Question 2

What category is M1202 in?

Accepted Answer

M1202 belongs to HCPCS Category M (Medical Services).

Question 3

When should I use HCPCS code M1202?

Accepted Answer

Use M1202 when billing for pt 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 M1202 covered by Medicare?

Accepted Answer

Coverage for M1202 (Pt 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 M1202?

Accepted Answer

Documentation for M1202 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).