HCPCS Level II M1315: Colorectal Cancer Screening Results Not Documented and Reviewed - OpenPayer

Summary & Overview

HCPCS Level II M1315: Colorectal Cancer Screening Results Not Documented and Reviewed

HCPCS Level II code M1315 denotes that colorectal cancer screening results were not documented and reviewed, with the reason listed as not otherwise specified. As a status/administrative code, M1315 flags incomplete documentation of a preventive screening process rather than indicating a clinical procedure. Nationally, accurate capture of such documentation issues matters for quality measurement, continuity of care, and claims adjudication because missing screening results can affect follow-up care and performance metrics.

Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of what the code represents, the typical service context and site of service, and an overview of how the code is used in administrative and quality reporting workflows. The publication also outlines benchmarks and payer policies where available, clarifies clinical context around colorectal cancer screening documentation, and summarizes coding considerations and common modifiers when documentation is incomplete.

This material is written for a national audience of clinicians, coders, and revenue cycle professionals seeking a clear understanding of M1315 and its implications for documentation, quality reporting, and claims processing.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareM1315HCPCS Level IIcolorectal screeningdocumentationpreventive carequality reportingoutpatient codingambulatory care

Billing Code Overview

HCPCS Level II code M1315 indicates that colorectal cancer screening results were not documented and reviewed; reason not otherwise specified. The service type for this code is documentation and review of colorectal cancer screening results; when results are not recorded, this code captures the omission and the unspecified reason for that omission. The typical site of service is outpatient or ambulatory care settings where colorectal cancer screening results would normally be documented and reviewed, including primary care offices and specialty clinics.

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Clinical & Coding Specifications

Clinical Context

A 62-year-old patient presents to a primary care clinic for routine colorectal cancer screening follow-up. The patient previously underwent a fecal immunochemical test (FIT) at an outside facility, but the screening result documentation was not available in the electronic health record at the time of the visit. The clinician documents that colorectal cancer screening results were not documented and reviewed, and selects billing code M1315 to indicate lack of documented screening results. Typical workflow: review outside records request, attempt to obtain prior screening reports (FIT, stool DNA, or colonoscopy), document inability to locate or review the results, and counsel the patient on next steps or repeat screening options. Typical site of service is outpatient primary care or preventive medicine clinic; the code may also be used in ambulatory specialty clinics (gastroenterology) when previous screening results cannot be verified.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural service	Use when work or time required to manage undocumented screening results is substantially greater than usual (documentation must support).
`23`

HCPCS M1423: Optimal Care for Urologic Conditions, MIPS Value Pathway

HCPCS-M1199-RENAL-REPLACEMENT-THERAPY-SERVICES

HCPCS M1199: Renal Replacement Therapy Services

HCPCS-M1437-TELEHEALTH-ENCOUNTER

HCPCS M1437: Encounters Conducted via Telehealth

HCPCS-M1415-NO-POSITIVE-PD-L1-BEFORE-FIRST-LINE-IMMUNOTHERAPY

HCPCS Level II M1415: No Positive PD-L1 Before First-Line Immunotherapy

HCPCS-M1416-HOSPICE-SERVICES-DURING-PERFORMANCE-PERIOD

HCPCS Level II M1416: Patient Received Hospice Services During Performance Period

HCPCS-LEVEL-II-M1326-HYPOTONY-EVALUATION-MANAGEMENT

HCPCS Level II M1326: Patients with Diagnosis of Hypotony

HCPCS-M1365-HOSPICE-PALLIATIVE-CARE-ENCOUNTER-SPECIALTY-17

HCPCS M1365: Hospice and Palliative Care Patient Encounter

HCPCS-M1263-HOSPICE-DIALYSIS-INITIATION-EVALUATION

HCPCS M1263: Hospice Patient Evaluation at Dialysis Initiation

HCPCS-M1161-ANAPHYLAXIS-DUE-TO-TDAP-VACCINE-PEDIATRIC

HCPCS M1161: Anaphylaxis Due to Tetanus/Diphtheria/Pertussis Vaccine, Pediatric

HCPCS-M1359-INDEX-SUICIDE-RISK-ASSESSMENT-C-SSRS

HCPCS M1359: Index Suicide Risk Assessment with Non-Zero C-SSRS Score

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Taxonomy Code	Specialty	Notes
`207Q00000X`	Family Medicine	Primary care clinicians who order and follow colorectal cancer screening.
`207R00000X`	Internal Medicine	Internists managing preventive screening and follow-up.
`207L00000X`	Gastroenterology	Specialists who perform diagnostic and therapeutic colorectal procedures when prior screening documentation is missing.
`363A00000X`	Nurse Practitioner	Advanced practice providers who perform screening assessments and coordinate records retrieval.
`367500000X`	Physician Assistant	PAs who provide evaluation and management for preventive services.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`Z12.11`	Encounter for screening for malignant neoplasm of colon	Common screening encounter code when evaluating colorectal cancer screening status and results are not documented.
`Z12.12`	Encounter for screening for malignant neoplasm of rectum	Used when the focus is rectal cancer screening and prior results are unavailable.
`Z09`	Encounter for follow-up examination after completed treatment for conditions other than malignant neoplasm	Used if follow-up for prior colorectal condition where screening documentation is missing.
`R68.89`	Other general symptoms and signs	May be applied when non-specific symptoms prompt review of screening and results are not documented.
`Z00.00`	Encounter for general adult medical examination without abnormal findings	Used for routine preventive visits where documented screening results are absent.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`45378`	Colonoscopy, flexible, diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)	Performed when screening results are unavailable and a diagnostic colonoscopy is indicated to complete colorectal cancer screening.
`82270`	Blood, occult, by peroxidase activity (e.g., guaiac), qualitative; feces, single smear	An older stool-based test sometimes repeated or performed if prior results are missing.
`81528`	Molecular assay for colorectal cancer screening, stool DNA, includes assay for hemoglobin, qualitative, each	Alternative noninvasive stool-based screening test ordered when prior documentation cannot be verified.
`G0105`	Colorectal cancer screening; colonoscopy on individual at high risk	Used for screening colonoscopy in patients at high risk when prior results are undocumented and colonoscopy is indicated.
`G0121`	Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk	Used for average-risk screening colonoscopy when prior screening documentation is missing and colonoscopy is scheduled.

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