Question 1

What is HCPCS code M1469?

Accepted Answer

HCPCS code M1469 is "Hx of hep b, or pos bld test". Patient has a history of hepatitis b illness or received a hepatitis b surface antigen, hepatitis b surface antibody, or total antibody to hepatitis b core antigen test with a positive result any time before or during the measurement period

Question 2

What category is M1469 in?

Accepted Answer

M1469 belongs to HCPCS Category M (Medical Services).

Question 3

When should I use HCPCS code M1469?

Accepted Answer

Use M1469 when billing for hx of hep b, or pos bld test. 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 M1469 covered by Medicare?

Accepted Answer

Coverage for M1469 (Hx of hep b, or pos bld test) 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 M1469?

Accepted Answer

Documentation for M1469 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).