Question 1

What is HCPCS code M1238?

Accepted Answer

HCPCS code M1238 is "Doc 2nd recom hzv 2-6 mo int". Documentation that administration of second recombinant zoster vaccine could not occur during the performance period due to the recommended 2-6 month interval between doses (i.e, first dose received after october 31)

Question 2

What category is M1238 in?

Accepted Answer

M1238 belongs to HCPCS Category M (Medical Services).

Question 3

When should I use HCPCS code M1238?

Accepted Answer

Use M1238 when billing for doc 2nd recom hzv 2-6 mo int. 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 M1238 covered by Medicare?

Accepted Answer

Coverage for M1238 (Doc 2nd recom hzv 2-6 mo int) 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 M1238?

Accepted Answer

Documentation for M1238 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).