Summary & Overview
HCPCS M1301: Tobacco Cessation Intervention for Identified Tobacco Users
HCPCS Level II code M1301 documents that a patient identified as a tobacco user received a tobacco cessation intervention—counseling and/or pharmacotherapy—during the measurement period or in the six months prior. This measure supports tracking delivery of evidence-based cessation services, which are key to reducing tobacco-related morbidity and healthcare costs nationwide. Capture of this code signals adherence to quality measurement frameworks and can affect reporting for population health and value-based programs.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for tobacco cessation interventions, common settings where the service is delivered, and typical use cases for quality reporting. The publication summarizes benchmarks and reporting implications, clarifies coding context for clinicians and billing staff, and highlights where M1301 fits within preventive care and chronic disease management workflows.
This national-level summary is intended to help administrators, coders, clinicians, and policy analysts understand the role of HCPCS Level II code M1301 in documenting tobacco cessation services and supporting quality measurement and reporting programs.
Billing Code Overview
HCPCS Level II code M1301 indicates that a patient identified as a tobacco user received a tobacco cessation intervention during the measurement period or in the six months prior to the measurement period. The intervention may include counseling and/or pharmacotherapy as part of tobacco use treatment.
Service Type: Preventive/behavioral health intervention for tobacco cessation
Typical Site of Service: Primary care clinics, outpatient behavioral health settings, ambulatory care, and community health programs
Clinical & Coding Specifications
Clinical Context
A 47-year-old patient presents to a primary care clinic for an annual wellness visit and is identified during screening as a current tobacco user. The medical assistant documents tobacco use in the electronic health record. During the visit the clinician provides a brief tobacco cessation counseling intervention (motivational brief counseling, discussion of quit strategies, and review of pharmacotherapy options) and prescribes nicotine replacement therapy. Counseling is documented in the note with duration and content, pharmacotherapy prescription is recorded, and follow-up is arranged within the next 30 days. The clinic staff codes the encounter with billing code M1301 to indicate the patient received tobacco cessation intervention during the measurement period or in the six months prior, and appends appropriate modifiers when the encounter circumstances require them (for example, an unrelated significant procedure or service, or an out-of-office service). Typical workflow steps: pre-visit tobacco screening by clinical staff; clinician counseling and shared decision-making; documentation of counseling content, duration, and pharmacotherapy; prescription or provision of cessation pharmacotherapy; scheduling of follow-up or referral to tobacco cessation program; charge entry with M1301 and applicable modifiers; maintenance of supporting documentation for quality measurement and audit purposes.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|