Question 1

What is HCPCS code M1323?

Accepted Answer

HCPCS code M1323 is "Pts 7wk inj, scrn iop >25". Patients seen within 7 weeks following the date of injection and are screened for elevated intraocular pressure (iop) with tonometry with documented iop >25 mm hg and a plan of care was documented

Question 2

What category is M1323 in?

Accepted Answer

M1323 belongs to HCPCS Category M (Medical Services).

Question 3

When should I use HCPCS code M1323?

Accepted Answer

Use M1323 when billing for pts 7wk inj, scrn 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 M1323 covered by Medicare?

Accepted Answer

Coverage for M1323 (Pts 7wk inj, scrn 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 M1323?

Accepted Answer

Documentation for M1323 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).