M1317 HCPCS Counseling Opt-Out Reimbursement | OpenPayer

Summary & Overview

HCPCS M1317: Counseling on Community Service Provider Connection, Patient Opt-Out

HCPCS Level II code M1317 denotes a documented counseling encounter in which a patient is counseled about connection with a community service provider (CSP) and explicitly opts out of the referral. The code captures a specific patient decision point—counseling occurred, options were offered, and the patient declined—making it useful for tracking patient preferences, care coordination activities, and documentation compliance across settings. Nationally, recording such opt-out decisions supports care continuity, quality measurement, and administrative clarity for payers and providers.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of what the code represents, common clinical contexts where it is used (outpatient primary care, behavioral health, and community health programs), and the typical service elements captured by the code. The publication outlines benchmarking considerations, common modifiers reported with similar encounter codes, and implications for documentation and claims processing. It also summarizes policy and billing guidance relevant to community linkage counseling and how M1317 fits into broader care coordination workflows.

Data not available in the input for payer-specific rates, associated taxonomies, and ICD-10 pairings.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareM1317HCPCS Level IIcommunity service linkagecare coordinationpatient counselingopt-out documentationoutpatient behavioral healthclaims documentation

Billing Code Overview

HCPCS Level II code M1317 describes counseling provided to patients who are counseled on connection with a community service provider (CSP) and explicitly opt out. The service is a patient counseling interaction focused on linkage to community-based supports where the patient declines the referral.

Service Type: Counseling on community service connection with documented patient opt-out

Typical Site of Service: Outpatient clinic, primary care or behavioral health setting, or community health program encounter

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A typical patient scenario involves an adult who presents to an outpatient primary care clinic or community health center seeking assistance with substance use services or screening for opioid or other substance use. During the visit, the clinician discusses linkage to a Certified Substance Provider (CSP) or community substance program, explains available treatment and support options, and documents that the patient was counseled about connection with a CSP but explicitly elects not to enroll or accept referral at that time. The encounter is counseling-focused and may occur during a routine office visit, a behavioral health screening visit, or a care-coordination session.

The clinical workflow: The patient completes screening (for example, a validated substance use questionnaire). The clinician reviews results, discusses CSP options, benefits and logistics of referral, and documents the counseling conversation, the patient’s understanding, and the patient’s explicit opt-out decision. Care team staff may provide educational materials and record the refusal in the medical record and care-management systems. If appropriate, the clinician documents follow-up plans and safety concerns, and schedules routine follow-up or crisis resources as needed.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when counseling required substantially greater work than typical for this service due to complexity.

HCPCS M1414: Documentation of Medical Reason for Not Performing PD-L1 Test

HCPCS-M1276-BMI-OUTSIDE-NORMAL-NO-FOLLOW-UP-DOCUMENTED

HCPCS M1276: BMI Outside Normal Parameters, No Follow-Up Documented

HCPCS-M1448-PERSONALITY-DISORDER-DIAGNOSIS-MEASURE

HCPCS M1448: Personality Disorder Diagnosis for Measurement

HCPCS-M1424-PULMONOLOGY-MIPS-VALUE-PATHWAY

HCPCS M1424: Pulmonology Care MIPS Value Pathway

HCPCS-M1222-GLAUCOMA-PLAN-OF-CARE-NOT-DOCUMENTED

HCPCS M1222: Glaucoma Plan of Care Not Documented

HCPCS-M1497-FALLS-NOT-PERFORMED-MEDICAL-REASONS-DOCUMENTATION

HCPCS M1497: Documentation of Falls Not Performed Due to Medical Reasons

HCPCS-M1299-INFLUENZA-IMMUNIZATION-ADMINISTERED-OR-PREVIOUSLY-RECEIVED

HCPCS M1299: Influenza Immunization Administered or Previously Received

HCPCS-M1228-HCV-TREATMENT-INITIATION-AFTER-VIREMIA

HCPCS M1228: HCV Treatment Initiation Within 3 Months of Reactive Antibody Test

HCPCS-M1480-ASSESSMENT-VALIDITY-IMPACTED-BY-PATIENT-CAPACITY-OR-MOTIVATION

HCPCS M1480: Assessment Validity Impacted by Patient Capacity or Motivation

HCPCS-M1219-ANAPHYLAXIS-VACCINE-REACTION-ENCOUNTER

HCPCS Level II M1219: Anaphylaxis Due to Vaccine on or Before Encounter Date

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Taxonomy Code	Specialty	Notes
208000000X	Family Medicine	Primary care clinicians commonly perform counseling and opt-out documentation.
208D00000X	Internal Medicine	General internists provide screening, counseling, and referral discussions.
2084P0800X	Addiction Medicine	Specialists who provide substance use counseling and linkage to CSPs.
363L00000X	Social Worker	Behavioral health and care-coordination professionals who document counseling and refusals.
206Q00000X	Physician Assistant	Mid-level clinicians who frequently perform counseling and documentation of opt-out decisions.

ICD-10 Code	Description	Clinical Relevance
Data not available in the input.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99408`	Alcohol and/or substance (other than tobacco) abuse structured screening and brief intervention services, 15 to 30 minutes	Commonly performed when screening identifies risky substance use and brief intervention and counseling are provided prior to opt-out.
`99409`	Alcohol and/or substance (other than tobacco) abuse structured screening and brief intervention services, greater than 30 minutes	Used when a longer counseling session occurs for linkage discussion before the patient opts out.
`96127`	Brief emotional/behavioral assessment (e.g., depression inventory, ADHD screening)	May be used for standardized screening that precipitates counseling and CSP referral discussion.
`99401`	Preventive counseling, individual, approximately 15 minutes (historical family planning/behavioral counseling codes — use depends on payer policies)	May be used for brief preventive counseling or behavior-change discussions associated with substance use counseling depending on payer rules.
`G0444`	Mental health collaborative care management services per month	May be billed in practices providing care management and coordination around behavioral health, which can include CSP linkage attempts and documentation of opt-out.

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