Question 1

What is HCPCS code M1409?

Accepted Answer

HCPCS code M1409 is "Recd gmln brca1/brca2 couns". Patients who received germline testing for brca1 and brca2 or genetic counseling completed within 6 months of diagnosis

Question 2

What category is M1409 in?

Accepted Answer

M1409 belongs to HCPCS Category M (Medical Services).

Question 3

When should I use HCPCS code M1409?

Accepted Answer

Use M1409 when billing for recd gmln brca1/brca2 couns. 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 M1409 covered by Medicare?

Accepted Answer

Coverage for M1409 (Recd gmln brca1/brca2 couns) 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 M1409?

Accepted Answer

Documentation for M1409 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).