Question 1

What is HCPCS code M1257?

Accepted Answer

HCPCS code M1257 is "Cvd risk assess not perf". Cvd risk assessment not performed or incomplete (e.g., cvd risk assessment was not documented), reason not otherwise specified

Question 2

What category is M1257 in?

Accepted Answer

M1257 belongs to HCPCS Category M (Medical Services).

Question 3

When should I use HCPCS code M1257?

Accepted Answer

Use M1257 when billing for cvd risk assess not perf. 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 M1257 covered by Medicare?

Accepted Answer

Coverage for M1257 (Cvd risk assess not perf) 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 M1257?

Accepted Answer

Documentation for M1257 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).