Summary & Overview
HCPCS Level II M1475: Huntington's Disease Care
HCPCS Level II code M1475 designates services provided for patients with a diagnosis of Huntington’s disease, a progressive neurodegenerative disorder. Nationally, this code matters because Huntington’s disease requires multidisciplinary, ongoing management—making accurate coding important for tracking utilization, coordinating specialty care, and informing coverage and resource planning. Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will learn what the code represents clinically, typical sites of service, and which major payers commonly process claims for this service. The publication also summarizes national benchmarks where available, recent policy updates affecting coverage and billing for neurodegenerative disease care, and the clinical context that supports use of this code. The piece is intended to help billing managers, revenue cycle staff, and policy analysts understand the role of M1475 in claims workflows and payer interactions, and to locate relevant policy and benchmark resources for Huntington’s disease care.
Billing Code Overview
HCPCS Level II code M1475 identifies services related to patients with diagnosis of Huntington's disease. This code is used to indicate services provided specifically for individuals diagnosed with this progressive neurodegenerative disorder.
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Service type: Clinical management and supportive care for Huntington's disease
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Typical site of service: Neurology clinics, movement disorder centers, outpatient specialty clinics, and other ambulatory settings focused on neurodegenerative disease care
Data not available in the input for payers, modifiers, taxonomies, ICD-10 diagnoses, related codes, and service line.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult diagnosed with Huntington's disease presenting to a neurology clinic or multidisciplinary movement disorders center for ongoing disease management and support services. The patient may experience chorea, cognitive decline, behavioral changes, and progressive motor dysfunction. The clinical workflow includes review of neurologic status, medication management (e.g., tetrabenazine or deutetrabenazine), assessment of functional abilities, counseling for safety and advanced care planning, coordination with physical, occupational, and speech therapy, and referral to social work or genetic counseling as needed. Typical site of service is an outpatient neurology clinic or specialty movement disorders clinic, with care often coordinated across home health or long-term care settings for advanced disease stages. Code M1475 is used to indicate services specific to patients with Huntington's disease in relevant administrative or billing contexts.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable evaluation and management service by the same physician on the same day of a procedure | Use when a distinct E/M visit is performed in addition to services for Huntington's disease management on the same day. |