Q: What category is M1325 in?

M1325 belongs to HCPCS Category M (Medical Services).

Q: When should I use HCPCS code M1325?

Use M1325 when billing for doc med rsn not seen. 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.

Q: Is M1325 covered by Medicare?

Coverage for M1325 (Doc med rsn not seen) 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.

Q: What documentation is required for M1325?

Documentation for M1325 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).

Question 1

What is HCPCS code M1325?

Accepted Answer

HCPCS code M1325 is "Doc med rsn not seen". Patients who were not seen for reasons documented by clinician for patient or medical reasons (e.g., inadequate time for follow-up, patients who received a prior intravitreal or periocular steroid injection within the last six (6) months and had a subsequent iop evaluation with iop <25mm hg within seven (7) weeks of treatment)

Question 2

What category is M1325 in?

Accepted Answer

M1325 belongs to HCPCS Category M (Medical Services).

Question 3

When should I use HCPCS code M1325?

Accepted Answer

Use M1325 when billing for doc med rsn not seen. 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 M1325 covered by Medicare?

Accepted Answer

Coverage for M1325 (Doc med rsn not seen) 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 M1325?

Accepted Answer

Documentation for M1325 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).