Question 1

What is HCPCS code M1211?

Accepted Answer

HCPCS code M1211 is "Gsa level>9.0%". Most recent glycemic status assessment (hba1c or gmi) level > 9.0%

Question 2

What category is M1211 in?

Accepted Answer

M1211 belongs to HCPCS Category M (Medical Services).

Question 3

When should I use HCPCS code M1211?

Accepted Answer

Use M1211 when billing for gsa level>9.0%. 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

What ICD-10 codes are commonly used with M1211?

Accepted Answer

Common ICD-10 diagnosis codes used with M1211 include: E08.01 (Diabetes mellitus due to underlying condition with hyperosmolarity with coma), E08.10 (Diabetes mellitus due to underlying condition with ketoacidosis without coma), E08.11 (Diabetes mellitus due to underlying condition with ketoacidosis with coma), E08.21 (Diabetes mellitus due to underlying condition with diabetic nephropathy). Always ensure proper medical documentation supports the medical necessity for the HCPCS code being billed.

Question 5

Is M1211 covered by Medicare?

Accepted Answer

Coverage for M1211 (Gsa level>9.0%) 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 6

What documentation is required for M1211?

Accepted Answer

Documentation for M1211 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).