Question 1

What is HCPCS code M1172?

Accepted Answer

HCPCS code M1172 is "Doc med rsn no td/tdap". Documentation of medical reason(s) for not administering td or tdap vaccine (e.g., prior anaphylaxis due to the td or tdap vaccine or history of encephalopathy within seven days after a previous dose of a td-containing vaccine)

Question 2

What category is M1172 in?

Accepted Answer

M1172 belongs to HCPCS Category M (Medical Services).

Question 3

When should I use HCPCS code M1172?

Accepted Answer

Use M1172 when billing for doc med rsn no td/tdap. 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 M1172 covered by Medicare?

Accepted Answer

Coverage for M1172 (Doc med rsn no td/tdap) 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 M1172?

Accepted Answer

Documentation for M1172 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).