Question 1

What is HCPCS code M1412?

Accepted Answer

HCPCS code M1412 is "Met nsclc w/ egfr alk oth ab". Patients with metastatic nsclc with epidermal growth factor receptor (egfr) mutations, alk genomic tumor aberrations, or other targetable genomic abnormalities with approved first-line targeted therapy, such as nsclc with ros1 rearrangement, braf v600e mutation, ntrk 1/2/3 gene fusion, met ex14 skipping mutation, and ret rearrangement

Question 2

What category is M1412 in?

Accepted Answer

M1412 belongs to HCPCS Category M (Medical Services).

Question 3

When should I use HCPCS code M1412?

Accepted Answer

Use M1412 when billing for met nsclc w/ egfr alk oth ab. 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 M1412 covered by Medicare?

Accepted Answer

Coverage for M1412 (Met nsclc w/ egfr alk oth ab) 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 M1412?

Accepted Answer

Documentation for M1412 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).