Question 1

What is HCPCS code M1274?

Accepted Answer

HCPCS code M1274 is "Pts snf exl mo". Patients who were admitted to a skilled nursing facility (snf) during the month of evaluation were excluded from that month

Question 2

What category is M1274 in?

Accepted Answer

M1274 belongs to HCPCS Category M (Medical Services).

Question 3

When should I use HCPCS code M1274?

Accepted Answer

Use M1274 when billing for pts snf exl mo. 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 M1274 covered by Medicare?

Accepted Answer

Coverage for M1274 (Pts snf exl mo) 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 M1274?

Accepted Answer

Documentation for M1274 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).