Question 1

What is HCPCS code M1306?

Accepted Answer

HCPCS code M1306 is "Pt anphx due to pneum". Patient had anaphylaxis due to the pneumococcal vaccine any time during or before the measurement period

Question 2

What category is M1306 in?

Accepted Answer

M1306 belongs to HCPCS Category M (Medical Services).

Question 3

When should I use HCPCS code M1306?

Accepted Answer

Use M1306 when billing for pt anphx due to pneum. 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 M1306 covered by Medicare?

Accepted Answer

Coverage for M1306 (Pt anphx due to pneum) 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 M1306?

Accepted Answer

Documentation for M1306 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).