HCPCS M1376
An additional encounter with an ra diagnosis during the performance period or prior performance period that is at least 90 days before or after an encounter with an ra diagnosis during the performance period
HCPCS
M1376
Medical Services
Description
An additional encounter with an ra diagnosis during the performance period or prior performance period that is at least 90 days before or after an encounter with an ra diagnosis during the performance period
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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