Summary & Overview
HCPCS Level II M1295: Total Colectomy or Colorectal Cancer History
HCPCS Level II code M1295 designates patients with a diagnosis or past history of total colectomy or colorectal cancer, serving as an important clinical identifier used across surgical and oncology settings. Nationally, this code matters for documentation of surgical history, continuity of oncology care, pre-procedure risk assessment, and for payers to classify patients for utilization and coverage determinations. Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
Readers will learn the clinical context and typical sites of service where M1295 is applied, the common modifiers associated with services billed alongside this classification, and which payers commonly recognize the code for administrative and coverage purposes. The publication also outlines benchmarks and policy updates relevant to documentation and claims processing, and provides guidance on how the code interacts with service lines such as surgical follow-up and oncology clinic visits. Data not available in the input is noted where applicable; the focus remains on national implications for billing, clinical communication, and payer interactions.
Billing Code Overview
HCPCS Level II code M1295 identifies patients with a diagnosis or past history of total colectomy or colorectal cancer. This code is used to denote clinical status related to removal of the colon or a malignancy of the colorectum.
Service type: Surgical history / oncologic follow-up classification
Typical site of service: Hospital inpatient, outpatient surgical centers, and oncology clinics
Clinical & Coding Specifications
Clinical Context
A 62-year-old patient with a prior total colectomy for ulcerative colitis presents for routine surveillance and management related to their colectomy and colorectal cancer history. The patient attends a gastroenterology or colorectal surgery clinic for review of symptoms (abdominal pain, changes in stoma output, or surveillance concerns) and for coordination of ongoing care including imaging, oncology follow-up, stoma care, or referral for reconstructive or revision procedures. Typical workflow: referral and chart review, focused history and physical exam addressing prior colectomy and cancer history, review of prior pathology and imaging, symptom-directed diagnostics (laboratory tests, CT abdomen/pelvis, endoscopy of remaining rectum or stoma assessment if indicated), multidisciplinary care coordination (medical oncology, radiation oncology, wound/ostomy nurse), and documentation for billing under the appropriate HCPCS Level II code M1295 for patients with history of total colectomy or colorectal cancer when a payor-specific billing descriptor requires this HCPCS level II classification. Typical site of service: outpatient specialty clinic (gastroenterology or colorectal surgery), ambulatory surgical center for procedure-related visits, or hospital outpatient department for complex multidisciplinary visits. Typical patient scenario: postoperative surveillance visit following colectomy for colorectal malignancy with discussion of pathology, review of adjuvant therapy status, stoma assessment, and planning for any required interventions or imaging.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|