Question 1

What is HCPCS code M1430?

Accepted Answer

HCPCS code M1430 is "Ret exm ou no retinopthy doc". Retinal exam finding without evidence of retinopathy in both eyes with severity level documented (in measurement year or in the prior year)

Question 2

What category is M1430 in?

Accepted Answer

M1430 belongs to HCPCS Category M (Medical Services).

Question 3

When should I use HCPCS code M1430?

Accepted Answer

Use M1430 when billing for ret exm ou no retinopthy doc. 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 M1430 covered by Medicare?

Accepted Answer

Coverage for M1430 (Ret exm ou no retinopthy doc) 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 M1430?

Accepted Answer

Documentation for M1430 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).