Question 1

What is HCPCS code M1321?

Accepted Answer

HCPCS code M1321 is "Pts no 7wk inj,no iop,iop>25". Patients who were not seen within 7 weeks following the date of injection for follow up or who did not have a documented iop or no plan of care documented if the iop was >25 mm hg

Question 2

What category is M1321 in?

Accepted Answer

M1321 belongs to HCPCS Category M (Medical Services).

Question 3

When should I use HCPCS code M1321?

Accepted Answer

Use M1321 when billing for pts no 7wk inj,no iop,iop>25. 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 M1321 covered by Medicare?

Accepted Answer

Coverage for M1321 (Pts no 7wk inj,no iop,iop>25) 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 M1321?

Accepted Answer

Documentation for M1321 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).