Question 1

What is HCPCS code M1429?

Accepted Answer

HCPCS code M1429 is "Retinopathy in od, os, ou". Retinal exam finding with evidence of retinopathy in left, right or both eyes with severity level documented

Question 2

What category is M1429 in?

Accepted Answer

M1429 belongs to HCPCS Category M (Medical Services).

Question 3

When should I use HCPCS code M1429?

Accepted Answer

Use M1429 when billing for retinopathy in od, os, ou. 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 M1429 covered by Medicare?

Accepted Answer

Coverage for M1429 (Retinopathy in od, os, ou) 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 M1429?

Accepted Answer

Documentation for M1429 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).