Question 1

What is HCPCS code M1225?

Accepted Answer

HCPCS code M1225 is "Iop dec>=20% from base". Intraocular pressure (iop) reduced by a value of greater than or equal to 20% from the pre-intervention level

Question 2

What category is M1225 in?

Accepted Answer

M1225 belongs to HCPCS Category M (Medical Services).

Question 3

When should I use HCPCS code M1225?

Accepted Answer

Use M1225 when billing for iop dec>=20% from base. 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 M1225 covered by Medicare?

Accepted Answer

Coverage for M1225 (Iop dec>=20% from base) 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 M1225?

Accepted Answer

Documentation for M1225 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).