Question 1

What is HCPCS code M1385?

Accepted Answer

HCPCS code M1385 is "Pt rsn not seen 2nd pam". Documentation of patient reasons for patients who were not seen for the second pam survey (e.g., less than four months between baseline pam assessment and follow-up

Question 2

What category is M1385 in?

Accepted Answer

M1385 belongs to HCPCS Category M (Medical Services).

Question 3

When should I use HCPCS code M1385?

Accepted Answer

Use M1385 when billing for pt rsn not seen 2nd pam. 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 M1385 covered by Medicare?

Accepted Answer

Coverage for M1385 (Pt rsn not seen 2nd pam) 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 M1385?

Accepted Answer

Documentation for M1385 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).