Question 1

What is HCPCS code M1304?

Accepted Answer

HCPCS code M1304 is "No pneum vax admin 19+". Patient did not receive any pneumococcal conjugate or polysaccharide vaccine on or after their 19th birthday and before the end of the measurement period

Question 2

What category is M1304 in?

Accepted Answer

M1304 belongs to HCPCS Category M (Medical Services).

Question 3

When should I use HCPCS code M1304?

Accepted Answer

Use M1304 when billing for no pneum vax admin 19+. 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 M1304 covered by Medicare?

Accepted Answer

Coverage for M1304 (No pneum vax admin 19+) 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 M1304?

Accepted Answer

Documentation for M1304 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).