Question 1

What is HCPCS code M1311?

Accepted Answer

HCPCS code M1311 is "Aphlx to vax bef enc". Anaphylaxis due to the vaccine on or before the date of the encounter

Question 2

What category is M1311 in?

Accepted Answer

M1311 belongs to HCPCS Category M (Medical Services).

Question 3

When should I use HCPCS code M1311?

Accepted Answer

Use M1311 when billing for aphlx to vax bef enc. 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 M1311 covered by Medicare?

Accepted Answer

Coverage for M1311 (Aphlx to vax bef enc) 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 M1311?

Accepted Answer

Documentation for M1311 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).