HCPCS M1380
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"
Description
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"
Common Specialties
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
Quantum Health Services provides full-cycle revenue cycle management and medical billing services nationwide. This code reference is for educational purposes; always verify official payer policies. CPT© descriptors require proper AMA licensing.