Question 1

What is HCPCS code M1495?

Accepted Answer

HCPCS code M1495 is "Fall w/ poc, no fall". Patients that reported a fall occurred who had a plan of care for falls documented or patients that did not report a fall

Question 2

What category is M1495 in?

Accepted Answer

M1495 belongs to HCPCS Category M (Medical Services).

Question 3

When should I use HCPCS code M1495?

Accepted Answer

Use M1495 when billing for fall w/ poc, no fall. 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 M1495 covered by Medicare?

Accepted Answer

Coverage for M1495 (Fall w/ poc, no fall) 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 M1495?

Accepted Answer

Documentation for M1495 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).