Question 1

What is HCPCS code M1213?

Accepted Answer

HCPCS code M1213 is "No hx spiro prs spiro>=70%". No history of spirometry results with confirmed airflow obstruction (fev1/fvc < 70%) and present spirometry is >= 70%

Question 2

What category is M1213 in?

Accepted Answer

M1213 belongs to HCPCS Category M (Medical Services).

Question 3

When should I use HCPCS code M1213?

Accepted Answer

Use M1213 when billing for no hx spiro prs spiro>=70%. 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 M1213 covered by Medicare?

Accepted Answer

Coverage for M1213 (No hx spiro prs spiro>=70%) 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 M1213?

Accepted Answer

Documentation for M1213 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).