M1358 HCPCS Reimbursement & Policy Benchmarks | OpenPayer

Summary & Overview

HCPCS M1358: Persistent Suicidal Ideation or Behavior on Follow-Up

HCPCS Level II code M1358 documents patients who did not experience a reduction in suicidal ideation and/or behavior on follow-up assessment within 120 days of the index assessment. The code captures an important clinical outcome used in behavioral health quality measurement and care monitoring. Nationally, tracking persistence of suicidal ideation is critical for population safety monitoring, care coordination, and quality reporting across outpatient mental health services.

Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of what the code represents, its relevance to behavioral health follow-up and quality measurement, typical care settings where it is used, and what to expect in payer coverage considerations. The publication also summarizes common modifiers and notes where additional data are not available.

This material provides clinical and administrative context for clinicians, coding professionals, and policy analysts seeking to understand how persistence of suicidal ideation is recorded in claims and why that matters for monitoring outcomes and aligning care pathways across major payers.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareM1358HCPCS Level IIbehavioral healthsuicidal ideationfollow-up assessmentquality measurementmental health outcomesambulatory care

Billing Code Overview

HCPCS Level II code M1358 indicates patients who did not have a reduction in suicidal ideation and/or behavior upon follow-up assessment within 120 days of the index assessment. This code represents a clinical follow-up outcome measure focused on persistent suicidal thoughts or behaviors after an initial evaluation.

Service type: Follow-up outcome assessment for persistent suicidal ideation and/or behavior
Typical site of service: Behavioral health outpatient settings, clinical follow-up visits, and other ambulatory mental health care environments

Clinical & Coding Specifications

Clinical Context

A 28-year-old patient presents to an outpatient behavioral health clinic after an initial comprehensive suicide risk assessment documented active suicidal ideation with a plan. The index assessment is performed by a licensed mental health clinician and communicated to the patient's primary care provider and crisis team. The patient is engaged in a safety plan, start of medication management by a psychiatrist, and scheduled follow-up at 30, 60, and 90 days. At the 120-day follow-up assessment the clinician documents that suicidal ideation and/or behaviors have not decreased compared with the index assessment. The clinical workflow includes: initial risk assessment and documentation, coordination of care with psychiatry and crisis services, ongoing psychotherapy or case management, timely follow-up assessment within the 120-day window, and documentation of unchanged or worsening suicide-related symptoms to support billing under M1358.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when work, time, or intensity of assessment and coordination substantially exceeds typical for a follow-up suicide risk evaluation.
`23`

HCPCS M1272: Kidney or Kidney-Pancreas Transplant Waitlist Membership

HCPCS-M1328-ACUTE-VITREOUS-HEMORRHAGE-EVALUATION

HCPCS Level II M1328: Acute Vitreous Hemorrhage Evaluation

HCPCS-M1200-ACE-INHIBITOR-ARB-PRESCRIPTION

HCPCS M1200: ACE Inhibitor or ARB Therapy Prescribed During Measurement Period

HCPCS-M1196-INITIAL-ITCH-OR-SYMPTOM-SEVERITY-ASSESSMENT-NRS-VRS

HCPCS Level II M1196: Initial Itch/Symptom Severity Assessment (NRS/VRS/ItchyQuant)

HCPCS-M1149-NECK-PROM-UNABLE-TO-COMPLETE-DUE-TO-BARRIERS

HCPCS M1149: Neck PROM Not Completed Due to Patient Barriers

HCPCS-M1242-PATIENT-DID-NOT-RESPOND-PATIENT-CENTEREDNESS-QUESTION

HCPCS M1242: Patient Nonresponse to Patient-Centeredness Question

HCPCS-M1277-COLORECTAL-CANCER-SCREENING-RESULTS-DOCUMENTED-REVIEWED

HCPCS Level II M1277: Colorectal Cancer Screening Results Documented and Reviewed

HCPCS-M1352-SUICIDAL-IDEATION-BEHAVIOR-C-SSRS-ASSESSMENT

HCPCS M1352: Suicidal Ideation and Behavior Assessment

HCPCS-M1280-BILATERAL-MASTECTOMY-HISTORY

HCPCS Level II M1280: Bilateral Mastectomy or History of Bilateral Mastectomy

HCPCS-M1301-TOBACCO-CESSATION-INTERVENTION

HCPCS M1301: Tobacco Cessation Intervention for Identified Tobacco Users

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Taxonomy Code	Specialty	Notes
`103K00000X`	Clinical Social Worker	Common provider for suicide risk assessment and follow-up care.
`101Y00000X`	Psychiatrist	Provides medication management and diagnostic oversight for suicidal ideation.
`2084P0800X`	Clinical Psychologist	Performs psychotherapy and standardized risk assessments.
`363L00000X`	Nurse Practitioner - Psychiatry & Mental Health	Frequently performs follow-up assessments and care coordination.
`367A00000X`	Physician Assistant - Psychiatry & Neurology	Provides follow-up assessments under supervision where applicable.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`Z91.5`	Personal history of self-harm	Relevant for patients with prior self-harm who are at ongoing risk and require follow-up assessments.
`R45.851`	Suicidal ideation	Primary symptom code directly related to this measure and to documentation of unchanged ideation at 120 days.
`F32.9`	Major depressive disorder, single episode, unspecified	Common underlying diagnosis associated with suicidal ideation requiring follow-up.
`F33.1`	Major depressive disorder, recurrent, moderate	Recurrent depressive disorders often correlate with persistent suicidal ideation despite treatment.
`F41.1`	Generalized anxiety disorder	Anxiety disorders commonly co-occur and can sustain suicidal ideation if untreated.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`90791`	Psychiatric diagnostic evaluation (no medical services)	Typically performed at the index assessment to establish baseline risk and diagnosis prior to follow-up under `M1358`.
`90837`	Psychotherapy, 60 minutes with patient	Ongoing psychotherapy commonly scheduled between index and 120-day follow-up; documents treatment provided when ideation persists.
`99214`	Office or other outpatient visit, established patient, moderate complexity	Used for medically focused follow-up visits including assessment of suicidal ideation when significant medical decision-making is required.
`99492`	Initial psychiatric collaborative care management, first 70 minutes in the first calendar month	Used in collaborative care models that support ongoing management and monitoring leading up to the 120-day assessment.
`99484`	Care management services for behavioral health conditions, per month	Billed for structured care management services provided during the monitoring period when suicidal ideation persists.

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