Summary & Overview
HCPCS M1289: Tobacco User Without Cessation Intervention
HCPCS Level II code M1289 documents that a patient identified as a tobacco user did not receive a tobacco cessation intervention (counseling and/or pharmacotherapy) during the measurement period or in the prior six months. Nationally, this code matters for quality measurement, population health reporting, and payer performance on preventive care metrics because it flags missed opportunities for cessation support among patients who use tobacco.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the code's clinical meaning and service context, common billing considerations, and how the code is used in quality measurement and reporting. The publication also outlines typical sites of service and common modifiers associated with the code when available.
This resource is intended to give clinicians, billing staff, and policy analysts a clear summary of what M1289 represents, why it is tracked at the national level, and what areas of documentation and reporting it affects. Data not available in the input is noted where applicable.
Billing Code Overview
HCPCS Level II code M1289 indicates that a patient identified as a tobacco user did not receive tobacco cessation intervention during the measurement period or in the six months prior to the measurement period. The interventions referenced include counseling and/or pharmacotherapy, and the code documents the absence of those services for a patient flagged as a tobacco user.
Service type: Tobacco cessation screening and intervention documentation (absence of intervention)
Typical site of service: Outpatient clinical settings, primary care offices, and ambulatory care sites where tobacco use screening and cessation services are documented.
Clinical & Coding Specifications
Clinical Context
A 52-year-old primary care patient is documented in the electronic health record as a current tobacco user during an ambulatory visit for routine chronic disease management. The patient receives medication refills and brief counseling for hypertension and diabetes but the clinician documents that no tobacco cessation counseling or pharmacotherapy was provided during the measurement period and not in the prior six months. The clinical workflow begins with intake screening by medical support staff who record tobacco use status in the social history. The provider reviews the chart, addresses pressing clinical issues, and documents tobacco use without delivering counseling or prescribing nicotine replacement therapy or cessation medications. Coding staff assign the HCPCS Level II code M1289 to reflect that the patient was identified as a tobacco user and did not receive tobacco cessation intervention during the measurement period or in the prior six months. Typical sites of service include outpatient primary care clinics, specialty ambulatory clinics, and community health centers where screening occurs but cessation treatment is not delivered.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work required to document or report the encounter related to tobacco use identification was substantially greater than typical. |