Question 1

What is HCPCS code M1253?

Accepted Answer

HCPCS code M1253 is "Pts hu surv no amb plltv". Patients who respond on the patient experience hu survey that they did not receive care by the listed ambulatory palliative care provider in the last 60 days (disavowal)

Question 2

What category is M1253 in?

Accepted Answer

M1253 belongs to HCPCS Category M (Medical Services).

Question 3

When should I use HCPCS code M1253?

Accepted Answer

Use M1253 when billing for pts hu surv no amb plltv. 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 M1253 covered by Medicare?

Accepted Answer

Coverage for M1253 (Pts hu surv no amb plltv) 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 M1253?

Accepted Answer

Documentation for M1253 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).