Question 1

What is HCPCS code M1365?

Accepted Answer

HCPCS code M1365 is "Hosp+pall care spec code 17". Patient encounter during the performance period with hospice and palliative care specialty code 17

Question 2

What category is M1365 in?

Accepted Answer

M1365 belongs to HCPCS Category M (Medical Services).

Question 3

When should I use HCPCS code M1365?

Accepted Answer

Use M1365 when billing for hosp+pall care spec code 17. 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 M1365 covered by Medicare?

Accepted Answer

Coverage for M1365 (Hosp+pall care spec code 17) 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 M1365?

Accepted Answer

Documentation for M1365 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).