Question 1

What is HCPCS code M1185?

Accepted Answer

HCPCS code M1185 is "Imm ckpt inhib not hld no rx". Documentation of immune checkpoint inhibitor therapy not held and/or corticosteroids or immunosuppressants prescribed or administered was not performed, reason not given

Question 2

What category is M1185 in?

Accepted Answer

M1185 belongs to HCPCS Category M (Medical Services).

Question 3

When should I use HCPCS code M1185?

Accepted Answer

Use M1185 when billing for imm ckpt inhib not hld no rx. 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 M1185 covered by Medicare?

Accepted Answer

Coverage for M1185 (Imm ckpt inhib not hld no rx) 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 M1185?

Accepted Answer

Documentation for M1185 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).