Summary & Overview
HCPCS M1388: Exam for Recurrence of Melanoma
HCPCS Level II code M1388 denotes documentation of an exam performed specifically to evaluate patients for recurrence of melanoma. The code captures a focused clinical surveillance encounter intended to detect local, regional, or distant return of disease after prior diagnosis or treatment. Nationally, accurate coding for recurrence exams supports clinical continuity, appropriate monitoring, and administrative tracking of oncology follow-up services.
Key payers addressed in the discussion include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the code’s clinical context, typical sites of service, and common modifier usage (where provided). The publication outlines what to expect in payer coverage patterns, coding considerations relevant to oncology and dermatology follow-up workflows, and areas where policy updates or billing clarification commonly arise. Benchmarks and payer-specific policies are summarized to help billing and clinical teams align documentation with coverage criteria.
This summary is intended for a national audience and provides a concise reference on the role of M1388 in melanoma surveillance workflows, what documentation this code represents, and where to look for payer-specific policies.
Billing Code Overview
HCPCS Level II code M1388 documents an exam performed for recurrence of melanoma. This code describes clinical evaluation focused on assessing patients for signs of melanoma recurrence following prior diagnosis or treatment.
-
Service type: Clinical surveillance/examination for melanoma recurrence
-
Typical site of service: Oncology or dermatology clinic, outpatient surgical follow-up, or other ambulatory care settings where recurrence surveillance exams are performed
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 58-year-old patient with a prior history of cutaneous malignant melanoma presents to a dermatology clinic or surgical oncology outpatient clinic for evaluation of possible local recurrence at the primary resection site and regional lymph node basin. The visit includes targeted physical examination of the lesion site, palpation of regional lymph nodes, review of prior pathology reports, and documentation of any new skin lesions or changes in pigmentation. If suspicious findings are identified, the workflow proceeds to diagnostic steps such as punch or excisional biopsy (performed in clinic or minor procedure suite), dermoscopy imaging, and ordering of relevant imaging (ultrasound of lymph node basin or PET/CT) and pathology tests. The procedure documented by M1388 typically occurs in the ambulatory clinic, outpatient surgery center, or hospital outpatient department and is billed when an exam is performed specifically for evaluation of suspected or documented recurrence of melanoma. Typical clinical personnel include a dermatologist, surgical oncologist, or general surgeon; support staff may include nurses and medical assistants. Documentation should note prior melanoma history, date and site of prior excision, current findings, decision-making regarding biopsy or surveillance, and any specimen handling instructions for pathology.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services |