Question 1

What is HCPCS code M1284?

Accepted Answer

HCPCS code M1284 is "Pt 66+ snp or ltc pos > 90d". Patients age 66 or older in institutional special needs plans (snp) or residing in long term care with pos code 32, 33, 34, 54, or 56 for more than 90 consecutive days during the measurement period

Question 2

What category is M1284 in?

Accepted Answer

M1284 belongs to HCPCS Category M (Medical Services).

Question 3

When should I use HCPCS code M1284?

Accepted Answer

Use M1284 when billing for pt 66+ snp or ltc pos > 90d. 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 M1284 covered by Medicare?

Accepted Answer

Coverage for M1284 (Pt 66+ snp or ltc pos > 90d) 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 M1284?

Accepted Answer

Documentation for M1284 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).