Question 1

What is HCPCS code M1427?

Accepted Answer

HCPCS code M1427 is "Doc med rsn bone scn". Documentation of medical reason(s) for performing a bone scan (including documented pain related to prostate cancer, salvage therapy, other medical reasons)

Question 2

What category is M1427 in?

Accepted Answer

M1427 belongs to HCPCS Category M (Medical Services).

Question 3

When should I use HCPCS code M1427?

Accepted Answer

Use M1427 when billing for doc med rsn bone scn. 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 M1427 covered by Medicare?

Accepted Answer

Coverage for M1427 (Doc med rsn bone scn) 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 M1427?

Accepted Answer

Documentation for M1427 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).