Question 1

What is HCPCS code M1300?

Accepted Answer

HCPCS code M1300 is "Flu imm no admin doc rea". Influenza immunization was not administered for reasons documented by clinician (e.g., patient allergy or other medical reasons, patient declined or other patient reasons, vaccine not available or other system reasons)

Question 2

What category is M1300 in?

Accepted Answer

M1300 belongs to HCPCS Category M (Medical Services).

Question 3

When should I use HCPCS code M1300?

Accepted Answer

Use M1300 when billing for flu imm no admin doc rea. 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 M1300 covered by Medicare?

Accepted Answer

Coverage for M1300 (Flu imm no admin doc rea) 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 M1300?

Accepted Answer

Documentation for M1300 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).