Question 1

What is HCPCS code M1338?

Accepted Answer

HCPCS code M1338 is "Pt f/u 30-180 dys no + imprv". Patients who had follow-up assessment 30 to 180 days after the index assessment who did not demonstrate positive improvement or maintenance of functioning scores during the performance period

Question 2

What category is M1338 in?

Accepted Answer

M1338 belongs to HCPCS Category M (Medical Services).

Question 3

When should I use HCPCS code M1338?

Accepted Answer

Use M1338 when billing for pt f/u 30-180 dys no + imprv. 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 M1338 covered by Medicare?

Accepted Answer

Coverage for M1338 (Pt f/u 30-180 dys no + imprv) 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 M1338?

Accepted Answer

Documentation for M1338 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).