Summary & Overview

HCPCS M1319: CSP Contact After Positive High-Risk Screening

HCPCS Level II code M1319 documents follow-up contact by a community support provider with patients who screened positive for high-risk social or behavioral needs, with contact occurring within 60 days of screening. This code captures a targeted care-coordination activity aimed at addressing urgent social and behavioral determinants of health identified through screening. Nationally, such codes matter as payers and programs emphasize closing the loop on positive screens to reduce adverse outcomes and support population health management.

Key payers in scope include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the code's clinical and operational intent, typical service locations, and where this activity fits within care coordination and behavioral health workflows. The publication also outlines the types of benchmarks and policy updates relevant to adoption and billing of this encounter, and provides clinical context for how timely CSP contact aligns with quality and safety priorities.

This summary is intended for a national audience of payers, health system administrators, compliance officers, and clinical program leaders interested in coding practice, care coordination metrics, and policy implications for screening follow-up.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareM1319HCPCS Level IIcare coordinationbehavioral healthsocial determinants of healthfollow-up contactcommunity support providerHRSN screening

Billing Code Overview

HCPCS Level II code M1319 describes care where patients had documented contact with a community support provider (CSP) for at least one of their screened positive high-risk suicide needs (HRSNs) within 60 days after screening. The service type is follow-up contact/care coordination after positive HRSN screening. The typical site of service is ambulatory or community-based behavioral health and social services settings, including outpatient clinics, community health centers, and care coordination programs.

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Clinical & Coding Specifications

Clinical Context

A typical patient scenario involves an adult who screens positive on a health-related screening tool for a high-risk social need (HRSN) — for example, food insecurity, housing instability, transportation barriers, or interpersonal safety concerns — during a primary care or community health screening visit. Within 60 days of that positive screen, the patient has documented contact with a community service provider (CSP) to address at least one screened positive HRSN. The workflow begins with screening during a primary care visit or via outreach, documentation of the positive HRSN in the medical record, referral to a CSP (internal care coordinator or external community agency), and follow-up contact documented by the clinical team or care coordinator confirming CSP contact (phone, telehealth, documented warm handoff, or documented case management encounter). Typical sites of service include outpatient primary care clinics, community health centers, federally qualified health centers, behavioral health clinics, and care coordination programs. Typical patient examples include:

An adult with Z59.4 (lack of adequate food) identified on screening, referred to a local food bank; a care coordinator documents the patient spoke with the food bank within 30 days and assistance arranged.
An elderly patient screening positive for Z59.0 (homelessness) who is referred to a housing navigation CSP and has a documented intake call within 14 days.
A patient screening positive for transportation barriers who is connected to a community transportation service and has a documented scheduling contact within 7 days.
A family screening positive for safety concerns referred to a domestic violence advocacy CSP with a documented warm handoff and follow-up contact within 60 days.

The billing code M1319 is used to capture that the patient had documented contact with a CSP for at least one screened positive HRSN within 60 days after screening. Documentation should include the positive screen, the referral source, the CSP contacted, the date and mode of contact, and any resulting arrangements or next steps.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when services required substantially greater work than typical for the encounter (e.g., extensive care coordination documentation related to multiple complex HRSNs).
`23`	Unusual anesthesia	Not typically applicable; reserved for procedures requiring anesthesia when anesthesia was provided under unusual circumstances.
`52`	Reduced services	Use when the documented service was partially reduced or not completed (e.g., attempted CSP contact documented but incomplete).
`53`	Discontinued procedure	Use if the coordination attempt was discontinued due to patient clinical reasons before contact occurred.
`54`	Surgical care only	Not applicable to this non-procedural care coordination service.
`55`	Postoperative management only	Not applicable.
`56`	Preoperative management only	Not applicable.
`62`	Two surgeons	Not applicable to this service.
`AS`	Physician assistant for services in an ambulatory surgical center	Rarely applicable; use when a PA documents the coordination in an ASC context.
`CO`	Worker’s compensation jurisdictional reporting	Use when the service is billed under a state workers’ compensation claim requiring jurisdictional reporting modifiers.
`CQ`	Service furnished by a CAQH-certified non-physician provider under a qualified system	Use when applicable by payer policy for delegated community provider documentation (payer-specific).
`FX`	Split or shared anesthesia — physician service	Not applicable.
`FY`	Split or shared anesthesia — non-physician service	Not applicable.
`QK`	Medical direction of two, three, or four concurrent anesthesia procedures	Not applicable.
`QX`	CRNA service with medical direction	Not applicable.
`QY`	Medical direction of one CRNA by an anesthesiologist	Not applicable.

Taxonomy Code	Specialty	Notes
`208000000X`	Family Medicine	Primary care clinicians who screen and refer for HRSNs.
`208100000X`	Internal Medicine	Adult primary care physicians managing chronic conditions and social needs referrals.
`261QA1901X`	Case Management	Care coordinators and social workers documenting CSP contacts and care transitions.
`261QM0800X`	Health Education	Community health workers and patient navigators who perform outreach and warm handoffs.
`2086S0122X`	Geriatric Medicine	Providers addressing HRSNs in older adult populations and coordinating community services.

CPT Code	Description	Relationship to This Procedure
`99490`	Chronic care management services, at least 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month	Often provided alongside care coordination activities; documents ongoing management that may include HRSN follow-up and CSP contact documentation.
`99487`	Complex chronic care management services, first 60 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month	Used when complex care coordination is required for patients with multiple high-risk needs and extensive CSP engagement.
`98960`	Education and training for patient self-management by a qualified, nonphysician health care professional, face-to-face; individual, per session	May be performed before or after CSP referral to educate the patient about available community resources or programs.
`99401`	Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual, approximately 15 minutes	Can be used for brief counseling related to social needs screening results and referral planning.
`96160`	Administration of patient-focused health risk assessment instrument (e.g., health-related social needs screening), per standardized instrument	Used at the time of screening; precedes `M1319` when a positive screen triggers CSP referral and documented contact.

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