Question 1

What is HCPCS code M1237?

Accepted Answer

HCPCS code M1237 is "Pt rsn no scrn". Patient reason for not screening for food insecurity, housing instability, transportation needs, utility difficulties, and interpersonal safety (e.g., patient declined or other patient reasons)

Question 2

What category is M1237 in?

Accepted Answer

M1237 belongs to HCPCS Category M (Medical Services).

Question 3

When should I use HCPCS code M1237?

Accepted Answer

Use M1237 when billing for pt rsn no scrn. 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 M1237 covered by Medicare?

Accepted Answer

Coverage for M1237 (Pt rsn no scrn) 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 M1237?

Accepted Answer

Documentation for M1237 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).