Question 1

What is HCPCS code M1263?

Accepted Answer

HCPCS code M1263 is "Pts hosp dialysis dt". Patients in hospice on their initiation of dialysis date or during the month of evaluation

Question 2

What category is M1263 in?

Accepted Answer

M1263 belongs to HCPCS Category M (Medical Services).

Question 3

When should I use HCPCS code M1263?

Accepted Answer

Use M1263 when billing for pts hosp dialysis dt. 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 M1263 covered by Medicare?

Accepted Answer

Coverage for M1263 (Pts hosp dialysis dt) 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 M1263?

Accepted Answer

Documentation for M1263 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).