Q: What category is M1216 in?

M1216 belongs to HCPCS Category M (Medical Services).

Q: When should I use HCPCS code M1216?

Use M1216 when billing for no spiro doc no res doc. 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.

Q: Is M1216 covered by Medicare?

Coverage for M1216 (No spiro doc no res doc) 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.

Q: What documentation is required for M1216?

Documentation for M1216 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).

Question 1

What is HCPCS code M1216?

Accepted Answer

HCPCS code M1216 is "No spiro doc no res doc". No spirometry results with confirmed airflow obstruction (fev1/fvc < 70%) documented and/or no spirometry performed with results documented during the encounter

Question 2

What category is M1216 in?

Accepted Answer

M1216 belongs to HCPCS Category M (Medical Services).

Question 3

When should I use HCPCS code M1216?

Accepted Answer

Use M1216 when billing for no spiro doc no res doc. 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 M1216 covered by Medicare?

Accepted Answer

Coverage for M1216 (No spiro doc no res doc) 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 M1216?

Accepted Answer

Documentation for M1216 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).