M1316 Current Tobacco Non-User (HCPCS) Reimbursement | OpenPayer

Summary & Overview

HCPCS Level II M1316: Current Tobacco Non-User

HCPCS Level II code M1316 represents documentation that a patient is a current tobacco non-user. Capturing tobacco use status is a standard part of preventive care and clinical documentation, supporting population health initiatives, quality measurement, and care coordination nationwide. Use of a discrete code for non-use helps differentiate patients who may not require tobacco cessation interventions from those who do, and supports reporting for clinical registries and quality programs.

Key payers covered in this overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will learn the clinical context for using M1316, common sites and scenarios where the code is recorded, and the role this code plays in billing and documentation workflows. The publication also summarizes available benchmarks and policy implications where relevant and notes when additional data elements are not available.

This summary is intended for clinicians, medical coders, revenue cycle staff, and policy analysts who need a clear, national-level description of the code, its primary use case in clinical documentation, and the payers most frequently involved in claims processing for preventive and ambulatory services. Data not available in the input is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareM1316HCPCS Level IItobacco use statuspreventive careclinical documentationambulatory carequality measurementbilling

Billing Code Overview

HCPCS Level II code M1316 denotes Current tobacco non-user, indicating a patient who does not use tobacco products. This code is used to document tobacco use status as non-user in clinical and billing records.

Service type: Tobacco use status assessment
Typical site of service: Ambulatory and outpatient clinical settings, including primary care and preventive care visits

Clinical & Coding Specifications

Clinical Context

A typical patient scenario involves an adult patient attending a primary care or preventive health visit where tobacco use status is assessed and documented. The patient reports never having used tobacco or having quit long enough to be classified as a current non-user. The clinical workflow includes screening during intake or history of present illness, documentation of tobacco status in the medical record and problem list, and coding the encounter for quality reporting or population health registries. This status may be recorded by a medical assistant, nurse, or provider and used for preventive care metrics, health maintenance reminders, and public health reporting. Typical sites of service include outpatient primary care clinics, preventive medicine visits, employee health clinics, and telehealth encounters.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Rarely applicable; used when additional documented work beyond typical evaluation is performed during the visit that supports complexity related to counseling or complex social/behavioral assessment.
`23`	Unusual anesthesia	Not applicable for this non-procedural assessment; generally not used.

HCPCS M1483: HCV Sustained Virological Response (20 Weeks–12 Months)

HCPCS-M1395-CHEMOTHERAPY-INITIAL-REGIMEN-MANAGEMENT

HCPCS M1395: Initial Chemotherapy Regimen with Defined Duration

HCPCS-M1424-PULMONOLOGY-MIPS-VALUE-PATHWAY

HCPCS M1424: Pulmonology Care MIPS Value Pathway

HCPCS-M1249-PATIENT-UNDERSTANDS-IMPORTANT-TO-ME

HCPCS Level II M1249: Patient-reported Understanding of What Matters

HCPCS-M1165-HOSPICE-SERVICES-MEASUREMENT-PERIOD

HCPCS M1165: Hospice Services During Measurement Period

HCPCS-M1412-METASTATIC-NSCLC-TARGETED-THERAPY-EGFR-ALK-ROS1-BRAF-NTRK-MET-RET

HCPCS M1412: Metastatic NSCLC with Targetable Genomic Alterations

HCPCS-M1298-PREGNANCY-DOCUMENTATION-MEASUREMENT-PERIOD

HCPCS Level II M1298: Documentation of Patient Pregnancy

HCPCS-M1285-MAMMOGRAPHY-RESULTS-NOT-DOCUMENTED-REVIEW

HCPCS Level II M1285: Mammography Results Not Documented and Reviewed

HCPCS-LEVEL-II-M1292-FRAILTY-WITH-ADVANCED-ILLNESS-66-PLUS

HCPCS Level II M1292: Frailty with Advanced Illness in Patients 66+

HCPCS-M1290-PATIENT-EXCLUDED-ACTIVE-HYPERTENSION

HCPCS M1290: Patient Excluded for Active Hypertension

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Taxonomy Code	Specialty	Notes
`207Q00000X`	Family Medicine	Primary care clinicians who commonly document tobacco status.
`208D00000X`	Internal Medicine	Internists documenting preventive care and tobacco use status.
`363L00000X`	Preventive Medicine	Clinicians focusing on health maintenance and risk-factor documentation.
`207R00000X`	Nurse Practitioner	Advanced practice providers who frequently record tobacco status.
`344000000X`	Physician Assistant	Clinician extenders who document smoking status during encounters.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`Z72.0`	Tobacco use, current	Typically not applicable to a current non-user but included here for contrast and to support accurate population health coding strategies.
`Z87.891`	Personal history of nicotine dependence	Relevant when a patient is a former tobacco user and now classified as a current non-user for tobacco exposure tracking.
`F17.200`	Nicotine dependence, unspecified, uncomplicated	Included to indicate possible past dependence history when documenting current non-user status.
`Z11.3`	Encounter for screening for respiratory tuberculosis	Tobacco status may be documented during screening encounters, though not directly linked; included as an example of preventive screening contexts.
`Z00.00`	Encounter for general adult medical examination without abnormal findings	A common visit type during which tobacco non-user status is recorded for health maintenance.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99213`	Office or other outpatient visit for the evaluation and management of an established patient, typically 15 minutes	Commonly performed during the same visit when tobacco non-user status is documented as part of the history and preventive counseling.
`99406`	Tobacco use cessation counseling, intermediate, greater than 3 minutes up to 10 minutes	Performed when counseling is needed; not applicable if patient is a current non-user but may be used for reinforcement or relapse prevention if counseling was provided.
`99407`	Tobacco use cessation counseling, intensive, greater than 10 minutes	Used when extended cessation counseling is delivered; typically not required for a current non-user unless intensive prevention counseling occurred.
`G0438`	Annual wellness visit, first visit	Tobacco status documentation is a standard element of the annual wellness visit and aligns with reporting `M1316` for current non-user.
`G0439`	Annual wellness visit, subsequent visit	Subsequent wellness visits include tobacco use status updates; `M1316` may be reported to indicate the patient is a current non-user.

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