Question 1

What is HCPCS code M1415?

Accepted Answer

HCPCS code M1415 is "No pos pdl1 bef ici ther". Patients who did not have a positive pd-l1 biomarker expression test result prior to the initiation of first-line immune checkpoint inhibitor therapy

Question 2

What category is M1415 in?

Accepted Answer

M1415 belongs to HCPCS Category M (Medical Services).

Question 3

When should I use HCPCS code M1415?

Accepted Answer

Use M1415 when billing for no pos pdl1 bef ici ther. 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 M1415 covered by Medicare?

Accepted Answer

Coverage for M1415 (No pos pdl1 bef ici ther) 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 M1415?

Accepted Answer

Documentation for M1415 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).