Summary & Overview
HCPCS Level II M1320: Positive Result on Five-Item Screening
HCPCS Level II code M1320 denotes a documented positive result on at least one of a five-item screening tool. Nationally, standardized screening codes like this are important for tracking population-level screening activity, enabling care coordination, and supporting payment and quality measurement programs across ambulatory and community settings. The code reflects identification rather than treatment and is used where brief, structured screening is performed.
Key payers in this context include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will learn what the code represents clinically, typical sites of service where it applies, and which major payers include it in coverage discussions. The publication also summarizes expected benchmarks and policy considerations, explains clinical context for use of a five-item screening instrument, and highlights gaps where data are not available.
This summary is intended for national audiences of billing specialists, practice managers, policy analysts, and clinicians who need a concise reference to the code's purpose, payer relevance, and operational implications.
Billing Code Overview
HCPCS Level II code M1320 represents patients who screened positive for at least one of the five hoursns. This service indicates identification of patients with positive screening results on a targeted five-item screening instrument.
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Service type: Screening identification and documentation of positive response(s) on a five-item screening tool
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Typical site of service: Outpatient or ambulatory settings where brief screening is performed, including primary care clinics, behavioral health clinics, and community health centers
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 62-year-old primary care patient completes a behavioral health screening during a routine wellness visit and screens positive for at least one of the five high-risk substance use or mental health screening items (e.g., hazardous alcohol use, opioid risk, severe depression, suicidal ideation, or intimate partner violence). The clinician documents the positive screen, performs a focused assessment to clarify severity and immediate safety concerns, and initiates a brief intervention and safety planning as indicated. The workflow typically occurs in an outpatient primary care clinic, behavioral health integrated clinic, or a community health center. Nursing or medical assistant administers the screening tool, the primary care provider or behavioral health clinician reviews results, documents the positive screen in the medical record, and codes the encounter using the HCPCS Level II code M1320 for patients who screened positive for at least one of the five high-risk screening items. Follow-up planning may include referral to specialty behavioral health, safety monitoring, brief counseling during the same visit, and arrangement of next-step care within the clinic or via community resources. Typical site of service: outpatient clinic, community health center, or integrated behavioral health setting. Typical patient scenario: adult with chronic medical conditions presenting for routine care who endorses hazardous alcohol use on screening and receives brief counseling and referral resources during the visit.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 |