HCPCS M1305

Description

Patient received any pneumococcal conjugate or polysaccharide vaccine on or after their 19th birthday and before the end of the measurement period

Common Specialties

Family Medicine, Emergency Medicine

Documentation Requirements

• Document clinical indications and clear medical necessity supporting the encounter or procedure.
• Ensure complete provider signatures, credentials, date, and specific place of service (POS).
• Verify documentation strictly supports code specificity to prevent downcoding or claim denials.

Billing & Coding Tips

• Verify current payer fee schedules, NCCI edits, and Medically Unlikely Edits (MUEs).
• Append correct modifiers (e.g., 25, 59, 26, TC) where distinct procedural services or components apply.
• Confirm pre-authorization rules with Medicare, Medicaid, and commercial plans before submission.

Related Codes

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