Question 1

What is HCPCS code M1280?

Accepted Answer

HCPCS code M1280 is "Bilat mast/hx bi /unilat mas". Women who had a bilateral mastectomy or who have a history of a bilateral mastectomy or for whom there is evidence of a right and a left unilateral mastectomy

Question 2

What category is M1280 in?

Accepted Answer

M1280 belongs to HCPCS Category M (Medical Services).

Question 3

When should I use HCPCS code M1280?

Accepted Answer

Use M1280 when billing for bilat mast/hx bi /unilat mas. 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 M1280 covered by Medicare?

Accepted Answer

Coverage for M1280 (Bilat mast/hx bi /unilat mas) 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 M1280?

Accepted Answer

Documentation for M1280 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).