Question 1

What is HCPCS code M1459?

Accepted Answer

HCPCS code M1459 is "Pt hosp/pal care dur perf pd". Patient was in hospice or receiving palliative care services at any time during the performance period

Question 2

What category is M1459 in?

Accepted Answer

M1459 belongs to HCPCS Category M (Medical Services).

Question 3

When should I use HCPCS code M1459?

Accepted Answer

Use M1459 when billing for pt hosp/pal care dur perf pd. 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 M1459 covered by Medicare?

Accepted Answer

Coverage for M1459 (Pt hosp/pal care dur perf pd) 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 M1459?

Accepted Answer

Documentation for M1459 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).