Question 1

What is HCPCS code M1418?

Accepted Answer

HCPCS code M1418 is "Med rsn not up to date cov". Patients who are not up to date on their covid-19 vaccinations as defined by cdc recommendations on current vaccination because of a medical contraindication documented by clinician

Question 2

What category is M1418 in?

Accepted Answer

M1418 belongs to HCPCS Category M (Medical Services).

Question 3

When should I use HCPCS code M1418?

Accepted Answer

Use M1418 when billing for med rsn not up to date cov. 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 M1418 covered by Medicare?

Accepted Answer

Coverage for M1418 (Med rsn not up to date cov) 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 M1418?

Accepted Answer

Documentation for M1418 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).