Summary & Overview
HCPCS Level II M1310: Tobacco Use Screening and Cessation Intervention
HCPCS Level II code M1310 documents that a patient was screened for tobacco use and, when identified as a tobacco user, received a tobacco cessation intervention (counseling, pharmacotherapy, or both) during the measurement period or within the prior six months. This code captures a core preventive care activity that aligns with national public health priorities to reduce tobacco-related morbidity and mortality and supports quality measurement efforts tied to population health and value-based contracting. Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
Readers will learn what HCPCS Level II code M1310 represents clinically and operationally, where the service is typically delivered, and how it fits into preventive care workflows. The publication outlines common billing considerations, typical sites of service, and the role of M1310 in quality reporting and tobacco cessation initiatives. Data not available in the input for specific modifiers, taxonomies, ICD-10 diagnoses, related codes, and service line are noted where appropriate.
Billing Code Overview
HCPCS Level II code M1310 indicates that a patient was screened for tobacco use and, if identified as a tobacco user, received a tobacco cessation intervention during the measurement period or in the six months prior. Interventions may include counseling, pharmacotherapy, or both as described in the code text.
Service type: Preventive counseling and pharmacotherapy for tobacco cessation
Typical site of service: Outpatient clinical settings, primary care clinics, behavioral health clinics, and community-based preventive care settings
Clinical & Coding Specifications
Clinical Context
A 52-year-old patient presents to a primary care clinic for an annual wellness visit. The medical assistant asks standardized screening questions and documents current tobacco use. The clinician briefly counsels the patient on tobacco cessation, discusses behavioral strategies, and offers pharmacotherapy options such as nicotine replacement therapy or a prescription for varenicline. The clinician documents tobacco use status, the counseling provided, and whether pharmacotherapy was prescribed. If the patient had been identified as a tobacco user within the six months prior to the measurement period and received counseling or pharmacotherapy then, the encounter also qualifies. Typical workflow: medical assistant performs screening, documents status in the electronic health record; clinician provides brief cessation counseling (or refers to a tobacco cessation program) and prescribes or arranges pharmacotherapy when appropriate; all actions and timeframes are recorded to support billing under M1310 for quality reporting and measure documentation.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | When counseling or documentation reflects substantially greater effort or complexity than typical brief tobacco counseling. |