Question 1

What is HCPCS code M1434?

Accepted Answer

HCPCS code M1434 is "Orl chemo wthn 30 d post enc". Patient on oral chemotherapy on or within 30 days after denominator eligible encounter

Question 2

What category is M1434 in?

Accepted Answer

M1434 belongs to HCPCS Category M (Medical Services).

Question 3

When should I use HCPCS code M1434?

Accepted Answer

Use M1434 when billing for orl chemo wthn 30 d post enc. 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 M1434 covered by Medicare?

Accepted Answer

Coverage for M1434 (Orl chemo wthn 30 d post enc) 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 M1434?

Accepted Answer

Documentation for M1434 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).