Summary & Overview
HCPCS M1313: Tobacco Screening or Cessation Intervention Not Performed
HCPCS Level II code M1313 is used to indicate that tobacco screening was not performed or that tobacco cessation intervention was not provided during the measurement period or in the six months prior. Nationally, documenting the absence of tobacco-related preventive services has implications for quality measurement, reporting, and aggregated performance metrics across payers and health systems. This code is relevant to primary care, preventive services, and population health monitoring.
Key payers in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the code’s clinical context, how it maps to preventive screening workflows, and the implications for quality measurement and reporting. The publication summarizes common use cases, where the service is typically provided (outpatient and ambulatory settings), and what documentation this code represents. It also covers benchmarks and policy updates where available, and explains gaps in input data where specific payers’ implementation details or associated taxonomies and ICD-10 mappings were not provided. The goal is to give clinicians, billing staff, and policy analysts a concise national-level reference for code M1313 and the administrative context of documenting absence of tobacco screening or cessation intervention.
Billing Code Overview
HCPCS Level II code M1313 indicates tobacco screening not performed or tobacco cessation intervention not provided during the measurement period or in the six months prior to the measurement period. This code documents absence of tobacco-related preventive services during the defined measurement window.
-
Service type: Preventive screening/behavioral health screening documentation
-
Typical site of service: Outpatient clinic or ambulatory care settings where preventive screening and counseling would normally occur
Clinical & Coding Specifications
Clinical Context
A primary care patient presents for an annual preventive visit at an outpatient clinic. The clinician performs routine social history screening. During the visit the clinician documents that tobacco screening was not completed and no tobacco cessation counseling or intervention was provided during the measurement period or in the six months prior to the measurement period. Typical workflow: medical assistant rooms the patient, updates the social history in the EHR, clinician confirms smoking status. If screening is omitted, the clinician documents reason for omission (e.g., patient refusal, acute issue preventing preventive care, visit focused on urgent problem). Billing staff apply the M1313 HCPCS Level II code to indicate tobacco screening not performed or tobacco cessation intervention not provided for quality/measurement reporting. Typical site of service: outpatient clinic/office-based primary care practice, community health center, or preventive care clinic. Typical patient scenario: an adult patient with chronic comorbidities presents for same-day acute care; the visit addresses acute concerns and tobacco screening was deferred, with documentation supporting the omission within the measurement period.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work required is substantially greater than usual for counseling or additional services performed in same visit related to tobacco use documentation omission. |