Question 1

What is HCPCS code M1230?

Accepted Answer

HCPCS code M1230 is "Pt hcv rctv aby no f/u tst". Patient has a reactive hcv antibody test and does not have a follow up hcv viral test, or patient has a reactive hcv antibody test and has a follow up hcv viral test that detects hcv viremia and is not referred to a clinician who treats hcv infection within 1 month and does not have hcv treatment initiated within 3 months of the reactive hcv antibody test, reason not given

Question 2

What category is M1230 in?

Accepted Answer

M1230 belongs to HCPCS Category M (Medical Services).

Question 3

When should I use HCPCS code M1230?

Accepted Answer

Use M1230 when billing for pt hcv rctv aby no f/u tst. 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 M1230 covered by Medicare?

Accepted Answer

Coverage for M1230 (Pt hcv rctv aby no f/u tst) 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 M1230?

Accepted Answer

Documentation for M1230 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).