Summary & Overview
HCPCS M1355: Clinician-Rated Suicide Risk Assessment
HCPCS Level II code M1355 designates a clinician-rated assessment of suicide risk based on a clinician’s evaluation or a clinician-rated tool. This code captures documentation of suicide risk determination, which informs immediate safety planning, level-of-care decisions, and subsequent treatment pathways. Nationally, standardized capture of suicide risk supports quality measurement, coordination of behavioral health services, and adherence to safety protocols across care settings.
Key payers included in this overview are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of what the code represents, the clinical contexts in which it is used, and the types of documentation and service settings generally associated with the code. The publication reviews common modifiers and ancillary billing considerations where available, and outlines the typical clinical implications of reporting a clinician-rated suicide risk assessment.
This executive summary prepares clinicians, coders, and policy professionals to understand the role of M1355 in clinical workflow and billing. Data not available in the input is noted where applicable; the content focuses on national relevance rather than jurisdiction-specific rules.
Billing Code Overview
HCPCS Level II code M1355 describes a clinician-rated assessment of suicide risk based on the clinician's evaluation or use of a clinician-rated tool. The service is focused on clinical risk assessment and determination of a patient’s immediate safety needs.
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Service type: Behavioral health risk assessment
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Typical site of service: Outpatient behavioral health settings, emergency departments, inpatient psychiatric units, and other clinical environments where a clinician evaluates suicide risk
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Clinical & Coding Specifications
Clinical Context
A 28-year-old patient presents to an outpatient behavioral health clinic reporting passive suicidal ideation after recent stressors and a history of major depressive disorder. The treating clinician (psychiatrist, psychiatric nurse practitioner, or clinical psychologist) conducts a structured assessment using a clinician-rated tool (for example, Columbia-Suicide Severity Rating Scale administered and interpreted by the clinician) and documents a clinician-based suicide risk determination as part of the evaluation. The workflow includes triage by nursing staff, a focused mental status examination, administration and scoring of the clinician-rated suicide risk instrument, formulation of risk level (low, moderate, high) based on clinician judgment and tool results, safety planning when indicated, and documentation of the risk assessment in the electronic health record. If risk is moderate or high, the clinician coordinates same-day safety interventions such as crisis referral, intensified follow-up, or hospitalization. Typical sites of service include outpatient behavioral health clinics, psychiatric outpatient departments, community mental health centers, and emergency departments when suicide risk assessment is performed as part of evaluation and disposition planning.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work or resources for the suicide risk evaluation substantially exceed typical requirements and documentation supports unusual time, complexity, or intensity. |