Question 1

What is HCPCS code M1228?

Accepted Answer

HCPCS code M1228 is "Pt + hcv aby +vir w/ rx 3 mo". Patient, who has a reactive hcv antibody test, and has a follow up hcv viral test that detected hcv viremia, has hcv treatment initiated within 3 months of the reactive hcv antibody test

Question 2

What category is M1228 in?

Accepted Answer

M1228 belongs to HCPCS Category M (Medical Services).

Question 3

When should I use HCPCS code M1228?

Accepted Answer

Use M1228 when billing for pt + hcv aby +vir w/ rx 3 mo. 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 M1228 covered by Medicare?

Accepted Answer

Coverage for M1228 (Pt + hcv aby +vir w/ rx 3 mo) 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 M1228?

Accepted Answer

Documentation for M1228 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).