Question 1

What is HCPCS code M1278?

Accepted Answer

HCPCS code M1278 is "Pre-htn or htn doc, f/u indc". Elevated or hypertensive blood pressure reading documented, and the indicated follow-up is documented

Question 2

What category is M1278 in?

Accepted Answer

M1278 belongs to HCPCS Category M (Medical Services).

Question 3

When should I use HCPCS code M1278?

Accepted Answer

Use M1278 when billing for pre-htn or htn doc, f/u indc. 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 M1278 covered by Medicare?

Accepted Answer

Coverage for M1278 (Pre-htn or htn doc, f/u indc) 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 M1278?

Accepted Answer

Documentation for M1278 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).