Question 1

What is HCPCS code M1376?

Accepted Answer

HCPCS code M1376 is "Ra dx enc 90 days dur per pd". An additional encounter with an ra diagnosis during the performance period or prior performance period that is at least 90 days before or after an encounter with an ra diagnosis during the performance period

Question 2

What category is M1376 in?

Accepted Answer

M1376 belongs to HCPCS Category M (Medical Services).

Question 3

When should I use HCPCS code M1376?

Accepted Answer

Use M1376 when billing for ra dx enc 90 days dur per pd. 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 M1376 covered by Medicare?

Accepted Answer

Coverage for M1376 (Ra dx enc 90 days dur per pd) 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 M1376?

Accepted Answer

Documentation for M1376 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).