Question 1

What is HCPCS code M1255?

Accepted Answer

HCPCS code M1255 is "Pts w/ othr rsn vst,+prg tst". Patients who have another reason for visiting the clinic [not prenatal or postpartum care] and have a positive pregnancy test but have not established the clinic as an ob provider (e.g., plan to terminate the pregnancy or seek prenatal services elsewhere)

Question 2

What category is M1255 in?

Accepted Answer

M1255 belongs to HCPCS Category M (Medical Services).

Question 3

When should I use HCPCS code M1255?

Accepted Answer

Use M1255 when billing for pts w/ othr rsn vst,+prg tst. 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 M1255 covered by Medicare?

Accepted Answer

Coverage for M1255 (Pts w/ othr rsn vst,+prg tst) 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 M1255?

Accepted Answer

Documentation for M1255 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).