Summary & Overview
HCPCS Level II M1277: Colorectal Cancer Screening Results Documented and Reviewed
HCPCS Level II code M1277 denotes documentation and clinical review of colorectal cancer screening results. The code captures the administrative and clinical step that confirms screening tests were performed and results were evaluated, an important element in cancer screening workflows and population health management. Nationally, consistent documentation of screening outcomes supports quality measurement, timely follow-up for abnormal findings, and population-level screening rate tracking.
Key payers covered in this overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find context on how M1277 is used in outpatient and ambulatory settings, what the code signifies for clinical workflows, and the aspects of billing and reporting relevant to screening programs. The publication summarizes typical use cases, the service line implications for preventive care, and what to expect in payer coverage language when documentation of screening results is required.
This piece does not provide state-specific guidance. It outlines national clinical and billing context, highlights where M1277 fits within colorectal cancer screening processes, and flags areas where organizations commonly track performance. Data not available in the input is noted where applicable.
Billing Code Overview
HCPCS Level II code M1277 documents that colorectal cancer screening results were documented and reviewed. The service represents the recording and clinical review of colorectal cancer screening outcomes, indicating that screening tests were completed and the results were evaluated by a clinician.
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Service type: Screening result documentation and clinical review
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Typical site of service: Outpatient clinic or ambulatory care settings where colorectal cancer screening results are reviewed and incorporated into the medical record
Clinical & Coding Specifications
Clinical Context
A 58-year-old average-risk adult presents to a primary care clinic for routine preventive care. The patient completed a home fecal immunochemical test (FIT) and returned the kit; results were documented in the electronic health record and reviewed by the clinician. The clinician documents the colorectal cancer screening test result, communicates findings to the patient, and records follow-up recommendations in the chart. Typical workflow steps include verification of patient identity and screening history, receipt and verification of test result, EHR documentation of the result and interpretation, patient notification (telephone, portal message, or in-person), and placement of orders or referrals for colonoscopy if the screening result is positive or if surveillance is indicated.
Typical site of service: Primary care clinic or outpatient office, patient portal communication, specimen processing laboratory when applicable.
Typical patient scenario: Asymptomatic patient undergoing routine colorectal cancer screening using FIT with a positive result requiring documented review and referral for diagnostic colonoscopy; alternatively, a negative FIT with documented counseling on rescreening interval and return-to-screening instructions.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when documentation supports substantially greater work or complexity in reviewing and documenting screening results (rare for this code). |