Question 1

What is HCPCS code M1496?

Accepted Answer

HCPCS code M1496 is "No doc of fall or poc". Patients that had a fall who did not have a plan of care for falls documented or do not have documentation of being assessed for falls

Question 2

What category is M1496 in?

Accepted Answer

M1496 belongs to HCPCS Category M (Medical Services).

Question 3

When should I use HCPCS code M1496?

Accepted Answer

Use M1496 when billing for no doc of fall or poc. 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 M1496 covered by Medicare?

Accepted Answer

Coverage for M1496 (No doc of fall or poc) 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 M1496?

Accepted Answer

Documentation for M1496 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).