Question 1

What is HCPCS code M1380?

Accepted Answer

HCPCS code M1380 is "2 rx in perf pd any com meds". Filled at least two prescriptions during the performance period for any combination of the qualifying oral antipsychotic medications listed under "denominator note" or the long-acting injectable antipsychotic medications listed under "denominator note"

Question 2

What category is M1380 in?

Accepted Answer

M1380 belongs to HCPCS Category M (Medical Services).

Question 3

When should I use HCPCS code M1380?

Accepted Answer

Use M1380 when billing for 2 rx in perf pd any com meds. 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 M1380 covered by Medicare?

Accepted Answer

Coverage for M1380 (2 rx in perf pd any com meds) 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 M1380?

Accepted Answer

Documentation for M1380 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).