Question 1

What is HCPCS code M1307?

Accepted Answer

HCPCS code M1307 is "Doc pt pal or hospice". Documentation stating the patient has received or is currently receiving palliative or hospice care

Question 2

What category is M1307 in?

Accepted Answer

M1307 belongs to HCPCS Category M (Medical Services).

Question 3

When should I use HCPCS code M1307?

Accepted Answer

Use M1307 when billing for doc pt pal or hospice. 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 M1307 covered by Medicare?

Accepted Answer

Coverage for M1307 (Doc pt pal or hospice) 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 M1307?

Accepted Answer

Documentation for M1307 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).