Question 1

What is HCPCS code M1343?

Accepted Answer

HCPCS code M1343 is "Pt pam lvl 4 base or srt lin". Patients who are at pam level 4 at baseline or patients who are flagged with extreme straight line response sets on the pam or with excessive missing responses

Question 2

What category is M1343 in?

Accepted Answer

M1343 belongs to HCPCS Category M (Medical Services).

Question 3

When should I use HCPCS code M1343?

Accepted Answer

Use M1343 when billing for pt pam lvl 4 base or srt lin. 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 M1343 covered by Medicare?

Accepted Answer

Coverage for M1343 (Pt pam lvl 4 base or srt lin) 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 M1343?

Accepted Answer

Documentation for M1343 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).