Question 1

What is HCPCS code M1386?

Accepted Answer

HCPCS code M1386 is "Exc sx melmn or mlnm is". Patients with an excisional surgery for melanoma or melanoma in situ in the past 5 years with an initial ajcc staging of 0, i, or ii at the start of the performance period

Question 2

What category is M1386 in?

Accepted Answer

M1386 belongs to HCPCS Category M (Medical Services).

Question 3

When should I use HCPCS code M1386?

Accepted Answer

Use M1386 when billing for exc sx melmn or mlnm is. 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 M1386 covered by Medicare?

Accepted Answer

Coverage for M1386 (Exc sx melmn or mlnm is) 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 M1386?

Accepted Answer

Documentation for M1386 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).