M1386 HCPCS Reimbursement & Benchmarks

HCPCS Level II code M1386 designates patients who underwent excisional surgery for melanoma or melanoma in situ within the prior five years and who began the performance period with an AJCC stage of 0, I, or II. The code matters nationally as a way to identify a surgical melanoma cohort for quality measurement, surveillance programs, and performance reporting across payers. Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.

Readers will learn the clinical context for the code, expected sites of service, and the kinds of benchmarks and policy-related details typically associated with cohort-based HCPCS reporting. The publication outlines how M1386 is used to define eligible patient populations for follow-up or quality measurement, summarizes common modifiers and billing considerations provided in the input, and notes where input data are not available. This content is written for a national audience seeking concise guidance on the clinical scope and administrative use of HCPCS Level II code M1386.

Billing Code Overview

HCPCS Level II code M1386 applies to patients who have undergone an excisional surgery for melanoma or melanoma in situ within the past five years and who had an initial AJCC staging of 0, I, or II at the start of the performance period. This code identifies a defined cohort of melanoma surgical patients for programmatic tracking or quality measurement.

Service type: Surgical follow-up and post-excision surveillance cohort identification
Typical site of service: Outpatient surgical clinics, dermatologic surgery centers, and ambulatory oncology or dermatology follow-up settings

Clinical Context

A typical patient is a middle-aged adult who underwent an excisional surgery for cutaneous melanoma or melanoma in situ within the past five years and had an initial American Joint Committee on Cancer (AJCC) stage of 0, I, or II at the start of the performance period. The clinical workflow begins with a dermatology or surgical oncology evaluation for a suspicious pigmented lesion, biopsy confirming melanoma or melanoma in situ, and a definitive excisional procedure with clear margins. Postoperative pathology establishes tumor thickness (Breslow depth), ulceration status, and margin status to confirm AJCC stage 0–II.

Following excision, the patient enters a surveillance and care management period that may include wound care visits, scar management, periodic dermatologic skin checks, education on self-skin exams and sun protection, and documentation of absence of recurrence. Encounters occur in outpatient dermatology or surgical oncology clinics, with possible involvement of primary care for coordination. Imaging and sentinel lymph node biopsy may have been performed during the original treatment episode if clinically indicated for stage II; ongoing visits focus on surveillance for local recurrence, new primary melanomas, and management of surgical sequelae over the five-year performance window.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	When work, time, or complexity substantially exceeds usual for excisional surgery or related visits.

Taxonomy Code	Specialty	Notes
207N00000X	Dermatology	Dermatologists frequently perform diagnostic biopsies, excisions, and ongoing skin surveillance.
2084P0800X	Surgical Oncology	Surgical oncologists perform wide local excisions and manage definitive melanoma surgery planning.
207Q00000X	General Surgery	General surgeons perform cutaneous excisions and manage complex closures when involved.
363L00000X	Physician Assistant	PAs often assist in surgery and provide postoperative and surveillance care.
364S00000X	Nurse Practitioner	NPs provide surveillance visits, wound care, and patient education.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C43.9`	Malignant melanoma of skin, unspecified	Represents invasive melanoma cases that may have undergone excisional surgery and require surveillance.
`C43.0`	Malignant melanoma of lip	Site-specific melanoma that can be treated with excision and staged initial AJCC 0–II.
`C43.1`	Malignant melanoma of eyelid, including canthus	Head and neck melanomas requiring specialized excision and follow-up.
`D03.9`	Melanoma in situ, unspecified	Noninvasive melanoma treated with excisional surgery; included in the performance period criteria.
`D03.0`	Melanoma in situ of lip	Melanoma in situ on specific sites treated with excision and surveillance.
`Z85.820`	Personal history of malignant melanoma of skin	Used during follow-up to indicate prior melanoma and eligibility for surveillance services.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`11640`	Excision, malignant lesion including margins, trunk, arms or legs; excised diameter 2.1 to 3.0 cm	Commonly used for definitive excision of cutaneous melanoma on extremities when lesion size fits range.
`11646`	Excision, malignant lesion including margins, head, neck, hands, feet, genitalia; excised diameter 2.1 to 3.0 cm	Used when melanoma excision is on cosmetically or functionally sensitive sites requiring specific coding.
`38300`	Harvest of free skin graft (includes obtaining graft)	Performed when skin grafting is required after wide local excision to achieve closure.
`38792`	Sentinel lymph node biopsy, including injection and imaging when performed	Performed concurrently or during staging for higher-risk stage II melanomas to assess nodal status.
`99213`	Office or other outpatient visit for the evaluation and management of an established patient, low to moderate complexity	Typical for postoperative and surveillance visits during the five-year performance period.
`99397`	Periodic comprehensive preventive medicine reevaluation and management of an individual, established patient; adult, 65 years and older	May be used for comprehensive annual surveillance in older patients when appropriate.

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Summary & Overview

HCPCS Level II M1386: Excisional Surgery Cohort for Melanoma Stages 0–II