Question 1

What is HCPCS code M1497?

Accepted Answer

HCPCS code M1497 is "No doc fall med rsn". Documentation of falls not performed due to medical reasons  (e.g., syncope, vertigo and related disorders, restless leg syndrome, tourette syndrome/tic disorder, back pain, concussion/mild traumatic brain injury (mtbi), cervical dystonia, or epilepsy)

Question 2

What category is M1497 in?

Accepted Answer

M1497 belongs to HCPCS Category M (Medical Services).

Question 3

When should I use HCPCS code M1497?

Accepted Answer

Use M1497 when billing for no doc fall med rsn. 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 M1497 covered by Medicare?

Accepted Answer

Coverage for M1497 (No doc fall med rsn) 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 M1497?

Accepted Answer

Documentation for M1497 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).