M1359 Index Suicide Risk Assessment HCPCS Reimbursement | OpenPayer

Summary & Overview

HCPCS M1359: Index Suicide Risk Assessment with Non-Zero C-SSRS Score

HCPCS Level II code M1359 captures an index assessment conducted during the denominator period when a clinician documents suicidal ideation and/or behavior or determines increased suicide risk and records a non-zero C-SSRS score. This code is important for quality measurement and reporting related to suicide risk screening and follow-up care, and it standardizes documentation of clinically significant findings that may trigger care pathways and safety planning.

Key payers included in this national overview are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the code’s clinical intent, typical service setting, and how the code maps to behavioral health assessment workflows. The publication summarizes common modifiers and practical billing considerations provided in the input, and highlights the role of M1359 in denominator-period quality reporting and care coordination for patients with elevated suicide risk.

The content provides benchmarks and policy context where available and notes when specific data elements are not supplied. Clinicians, billers, and policy analysts will gain clarity on the code’s purpose, likely sites of service, and the kinds of clinical encounters that generate this billing entry.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareM1359HCPCS Level IIsuicide risk assessmentC-SSRSbehavioral healthquality measurementindex assessmentoutpatient mental healthscreening

Billing Code Overview

HCPCS Level II code M1359 represents an index assessment during the denominator period performed when suicidal ideation and/or behavior symptoms or increased suicide risk are identified by clinician determination and a non-zero C-SSRS score is obtained. This code documents the assessment event tied to suicide risk evaluation using the Columbia-Suicide Severity Rating Scale (C-SSRS).

Service Type: Suicide risk assessment / behavioral health assessment during quality measure denominator period

Typical Site of Service: Outpatient behavioral health or primary care setting where clinician-determined suicide risk screening and scoring occur

Clinical & Coding Specifications

Clinical Context

A 28-year-old patient presents to an outpatient behavioral health clinic reporting increased thoughts of self-harm over the prior week after a recent psychosocial stressor. During the scheduled visit the clinician administers the Columbia-Suicide Severity Rating Scale (C-SSRS) and documents current suicidal ideation without intent. The clinician determines an increased suicide risk and records a non-zero C-SSRS score. The visit is billed using M1359 as the index assessment falling within the program denominator period. Typical workflow: initial triage and safety screening; focused suicide risk assessment with the C-SSRS; documentation of clinician determination of elevated risk; development of a brief safety plan or disposition decision; coding and charge capture using M1359. Typical sites of service include outpatient behavioral health clinics, community mental health centers, crisis clinics, and emergency departments when the C-SSRS is used as the documented index assessment.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when work required is substantially greater than typical for the assessment (extensive documentation or complexity).

HCPCS M1497: Documentation of Falls Not Performed Due to Medical Reasons

HCPCS-M1288-DOCUMENTED-REASON-NOT-SCREENING-HIGH-BLOOD-PRESSURE

HCPCS M1288: Documented Reason for Not Screening or Recommending Follow-Up for High Blood Pressure

HCPCS-M1177-PNEUMOCOCCAL-VACCINE-ADULT

HCPCS M1177: Adult Pneumococcal Vaccination Status

HCPCS-M1180-IMMUNE-CHECKPOINT-INHIBITOR-THERAPY-MONITORING

HCPCS M1180: Patients on Immune Checkpoint Inhibitor Therapy

HCPCS-M1324-INTRAVITREAL-PERIOCULAR-CORTICOSTEROID-INJECTION

HCPCS M1324: Intravitreal or Periocular Corticosteroid Injection

HCPCS-M1192-ESOPHAGEAL-SQUAMOUS-CELL-CARCINOMA-PATIENT-CLASSIFICATION

HCPCS Level II M1192: Esophageal Squamous Cell Carcinoma, Established Diagnosis

HCPCS-LEVEL-II-M1375-RA-ADDITIONAL-ENCOUNTER-90-DAYS

HCPCS Level II M1375: Additional Rheumatoid Arthritis Encounter

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

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

HCPCS-M1154-HOSPICE-SERVICES-MEASUREMENT-PERIOD

HCPCS M1154: Hospice Services 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)

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Taxonomy Code	Specialty	Notes
`103K00000X`	Clinical Social Worker	Frequently performs suicide risk assessments and safety planning.
`2084P0800X`	Psychiatric-Mental Health Nurse Practitioner	Common provider for behavioral health assessments and C-SSRS administration.
`2084P0200X`	Psychiatrist	Responsible for diagnostic assessment, risk determination, and disposition.
`261QM0800X`	Licensed Professional Counselor	Performs standardized suicide screening and documentation in outpatient settings.
`207R00000X`	Behavioral Health Counselor	Provides risk assessments and brief interventions; documents C-SSRS results.

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 initial behavioral health visits; may include a C-SSRS as part of diagnostic assessment prior to billing `M1359`.
`90832`	Psychotherapy, 30 minutes with patient	May follow the risk assessment when brief psychotherapy is provided during the same visit.
`90834`	Psychotherapy, 45 minutes with patient	Used when a longer psychotherapy session occurs after the suicide risk assessment and is separately documented.
`99406`	Smoking and tobacco use cessation counseling, intermediate	Example of a behavior-change counseling code; not specific to suicide risk but commonly billed in behavioral health workflows when relevant.
`99407`	Smoking and tobacco use cessation counseling, intensive	As above; represents additional counseling that may be provided in the same visit when applicable.
`99214`	Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity	Common E/M code billed in conjunction with behavioral health assessment visits when medical decision-making supports the level of service documented.

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