Question 1

What is HCPCS code M1392?

Accepted Answer

HCPCS code M1392 is "Pt rsn no exm or lst to fu". Documentation of patient reasons for no examination, i.e., refusal of examination or lost to follow-up (documentation must include information that the clinician was unable to reach the patient by phone, mail or secure electronic mail - at least one method must be documented)

Question 2

What category is M1392 in?

Accepted Answer

M1392 belongs to HCPCS Category M (Medical Services).

Question 3

When should I use HCPCS code M1392?

Accepted Answer

Use M1392 when billing for pt rsn no exm or lst to fu. 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 M1392 covered by Medicare?

Accepted Answer

Coverage for M1392 (Pt rsn no exm or lst to fu) 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 M1392?

Accepted Answer

Documentation for M1392 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).