Question 1

What is HCPCS code M1221?

Accepted Answer

HCPCS code M1221 is "Dre w/o rtnopthy". Dilated retinal eye exam with interpretation by an ophthalmologist or optometrist or artificial intelligence (ai) interpretation documented and reviewed; without evidence of retinopathy

Question 2

What category is M1221 in?

Accepted Answer

M1221 belongs to HCPCS Category M (Medical Services).

Question 3

When should I use HCPCS code M1221?

Accepted Answer

Use M1221 when billing for dre w/o rtnopthy. 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 M1221 covered by Medicare?

Accepted Answer

Coverage for M1221 (Dre w/o rtnopthy) 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 M1221?

Accepted Answer

Documentation for M1221 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).