HCPCS Level II M1353: Suicide Safety Plan Not Completed - OpenPayer

Summary & Overview

HCPCS Level II M1353: Suicide Safety Plan Not Completed

HCPCS Level II code M1353 identifies clinical encounters where a suicide safety plan was not completed, initiated, reviewed, or updated in collaboration with a clinician within or concurrent with the index encounter. This measure signals gaps in documentation and delivery of a key safety intervention used across behavioral health and acute care settings to mitigate suicide risk. Nationally, consistent use of this code can inform quality measurement, care coordination, and risk management efforts across payers and providers.

Key payers in scope for analysis typically include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the code's clinical context and relevance, which settings and service types it applies to, and the common modifiers associated with HCPCS billing for behavioral health workflows. The publication outlines benchmarking and policy considerations relevant to payers listed above and highlights clinical documentation pathways tied to suicide safety planning.

This summary provides a concise reference for coding teams, quality leads, and payers seeking to understand how M1353 functions as an indicator of missed safety planning opportunities. Data not available in the input will be noted where applicable in subsequent sections.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareM1353HCPCS Level IIsuicide safety planbehavioral healthdocumentationquality measuremental healthpatient safetyclinical encounter

Billing Code Overview

HCPCS Level II code M1353 denotes patients who did not have a completed suicide safety plan initiated, reviewed, or updated in collaboration with their clinician (concurrent or within 24 hours) of the index clinical encounter. This code captures the absence of a documented, clinician-collaborative suicide safety plan tied to a specific clinical encounter.

Service type: Behavioral health safety planning and documentation
Typical site of service: Behavioral health settings, outpatient clinics, emergency departments, inpatient psychiatric units, or other clinical encounters where suicide risk assessment and safety planning would be expected

Clinical & Coding Specifications

Clinical Context

A patient presents to an outpatient behavioral health clinic for a scheduled psychotherapy visit after recent escalation of depressive symptoms and passive suicidal ideation. The clinician performs a focused risk assessment during the index encounter and determines that the patient is at low to moderate imminent risk for self-harm but declines a structured, documented suicide safety plan at that time. The care team documents the assessment, discusses safety resources, and arranges follow-up within 24–72 hours. Because a completed suicide safety plan was not initiated, reviewed, or updated in collaboration with the clinician concurrent with or within 24 hours of the encounter, the visit is captured by billing code M1353 to indicate lack of a completed safety plan.

Typical workflow elements:

Patient check-in and intake screening for mood and suicidality.
Clinician conducts suicide risk assessment (history, ideation, intent, plan, means).
Clinician offers a structured suicide safety plan and collaborative development; patient declines or the plan is not completed within the encounter or within 24 hours.
Clinician documents assessment, discussion of safety resources, crisis contacts, and follow-up plan.
Administrative coding flags the encounter with M1353 to denote absence of a completed safety plan within the required timeframe.

Typical site of service: outpatient behavioral health clinic, community mental health center, primary care behavioral health integration setting, or telehealth behavioral visit.

Coding Specifications

HCPCS Level II M1495: Fall Risk Assessment and Care Plan

HCPCS-M1270-NOT-ON-KIDNEY-TRANSPLANT-WAITLIST-STATUS

HCPCS Level II M1270: Not on Kidney or Kidney-Pancreas Transplant Waitlist

HCPCS-M1411-FIRST-LINE-IMMUNE-CHECKPOINT-INHIBITOR-NO-CHEMOTHERAPY

HCPCS M1411: First-Line Immune Checkpoint Inhibitor Without Chemotherapy

HCPCS-M1498-DIAGNOSTIC-RADIOLOGY-MIPS-VALUE-PATHWAY

HCPCS M1498: Diagnostic Radiology MIPS Value Pathway

HCPCS-M1186-HOSPICE-PALLIATIVE-CARE-ORDER-OR-RECEIVING

HCPCS Level II M1186: Hospice or Palliative Care Order/Receiving

HCPCS-M1476-COGNITIVE-IMPAIRMENT-ALZHEIMERS-CARE

HCPCS M1476: Cognitive Impairment and Alzheimer's Disease Services

HCPCS-M1297-BMI-NOT-DOCUMENTED-MEDICAL-REASON-OR-PATIENT-REFUSAL

HCPCS M1297: BMI Not Documented Due to Medical Reason or Patient Refusal

HCPCS-M1199-RENAL-REPLACEMENT-THERAPY-SERVICES

HCPCS M1199: Renal Replacement Therapy Services

HCPCS-M1475-HUNTINGTONS-DISEASE-CARE

HCPCS Level II M1475: Huntington's Disease Care

HCPCS-M1413-PD-L1-POSITIVE-PRE-FIRST-LINE-IMMUNOTHERAPY

HCPCS M1413: PD-L1 Positive Prior to First-Line Immune Checkpoint Inhibitor Therapy

Showing 1–10 of 356

Modifier	Description	When to Use
`22`	Increased procedural services	When work, time, or difficulty substantially exceeds typical for the service due to complex psychiatric evaluation without a completed safety plan.
`23`	Unusual anesthesia	Not typically applicable to this procedure; reserved for scenarios requiring unusual anesthesia.
`52`	Reduced services	When the suicide safety planning service was started but not completed for documented reasons.
`53`	Discontinued procedure	When safety plan discussion was initiated but discontinued due to patient or clinical factors.
`54`	Surgical care only	Not applicable; included for completeness but rarely used for behavioral services.
`55`	Postoperative management only	Not applicable to this service.
`56`	Preoperative management only	Not applicable to this service.
`62`	Two surgeons	Not applicable to behavioral health coding.
`AS`	Ambulatory surgical center payment status	Use when services are billed from an ambulatory surgical center setting if applicable.
`CQ`	Service furnished by non-physician practitioner in critical access hospital	Use when a physician assistant, nurse practitioner, or clinical nurse specialist furnishes the behavioral assessment in a qualifying facility.
`QX`	Modifier documenting AD/AS or CRNA assistant	Use when applicable for services involving qualified assistants in approved situations; rarely used for this service.
`QY`	Service furnished under a physician’s supervision by a PA, NP, or CNS	Use when the suicide risk assessment and related services are performed by a PA/NP/CNS under the physician’s supervision.

Taxonomy Code	Specialty	Notes
`103T00000X`	Clinical Social Worker	Frequently provides suicide risk assessments and safety planning in outpatient settings.
`2084P0800X`	Psychiatrist	Provides diagnostic assessment, management, and oversight of safety planning.
`1051A0400X`	Clinical Psychologist	Performs psychotherapy and risk assessment; contributes to safety plan development.
`363L00000X`	Nurse Practitioner — Psychiatry & Mental Health	Frequently delivers behavioral health visits and safety planning.
`206Q00000X`	Physician Assistant — Psychiatry	Provides assessments and collaborates on safety planning under supervision.

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

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`90791`	Psychiatric diagnostic evaluation (no medical services)	Often performed at intake or when suicidal ideation is identified; includes risk assessment that may lead to safety planning or, if not completed, documentation supporting `M1353`.
`90832`	Psychotherapy, 30 minutes with patient	Common follow-up psychotherapy session during which safety planning may be discussed or attempted; absence of a completed plan can trigger `M1353`.
`90834`	Psychotherapy, 45 minutes with patient	Standard individual therapy session where collaborative safety planning is frequently performed; if not completed within the encounter window, `M1353` applies.
`90837`	Psychotherapy, 60 minutes with patient	Extended psychotherapy where comprehensive safety planning is often appropriate; `M1353` documents when a plan is not completed.
`99406`	Smoking and tobacco use cessation counseling, intermediate	Example of a behavioral intervention CPT code that may be billed alongside behavioral health services; not specific to suicide planning but commonly co-occurs in behavioral health workflows.
`G0444`	Annual depression screening, 15 minutes	Screening that may identify suicidality and prompt risk assessment; absence of a completed safety plan after screening may be captured by `M1353`.

OpenPayer