Summary & Overview

HCPCS M1391: Recurrent Melanoma Patient Population

HCPCS Level II code M1391 designates the population of patients diagnosed with recurrent melanoma during the current performance period. As a population-identification measure, it supports tracking of cancer recurrence events, quality measurement, care coordination, and performance reporting across oncology and dermatology settings. Nationally, population measures for recurrent malignancies are important for monitoring outcomes, resource utilization, and adherence to follow-up and surveillance protocols.

Key payers addressed in this overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The content summarizes what M1391 represents, the clinical contexts where it is applied, and the types of benchmarks and policy considerations readers can expect to find in a full analysis.

Readers will learn the clinical scope and service settings tied to the code, common reporting and documentation implications, and where to look for related performance measures or administrative updates. If specific payer policies, modifier usage, taxonomies, or ICD-10 mappings are needed, those items are addressed in dedicated sections; where such data is not provided here, the document notes that the information was not available in the input.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareM1391HCPCS Level IImelanomarecurrent diseaseoncologyquality-measurepopulation-identificationoutpatient-care

Billing Code Overview

HCPCS Level II code M1391 identifies all patients who were diagnosed with recurrent melanoma during the current performance period. This measure captures patients with a documented diagnosis of recurrent melanoma and is intended to track the cohort of individuals experiencing disease recurrence.

Service type: Diagnostic/monitoring population identification for recurrent melanoma
Typical site of service: Oncology clinics, dermatology clinics, hospital outpatient departments, and other ambulatory care settings where cancer recurrence is evaluated or documented.

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A 62-year-old patient with a prior history of stage IIIC cutaneous melanoma presents to a multidisciplinary oncology clinic with new skin lesions and imaging findings concerning for recurrence. Dermatology performs full skin exam and biopsy of suspicious lesions; surgical oncology evaluates for wide local excision and possible sentinel lymph node biopsy; medical oncology coordinates systemic therapy options. Typical workflow: initial evaluation and history/physical by dermatologist or oncologist; diagnostic biopsy (clinic or OR) with pathology confirmation of recurrent melanoma; staging imaging (CT, PET/CT) ordered by oncology; multidisciplinary tumor board review; definitive local therapy (wide local excision ± lymph node procedure) performed in outpatient surgical suite or ambulatory surgery center; postoperative pathology and staging updates guide adjuvant systemic therapy or enrollment in clinical trials. Typical site of service: outpatient dermatology clinic, outpatient surgery center, ambulatory surgical center, or hospital outpatient department. Typical patient scenario: patient with previously treated melanoma develops a new pigmented lesion near prior scar and palpable regional lymphadenopathy; biopsy confirms recurrent melanoma, staging shows limited regional recurrence, and the patient undergoes surgical management with possible adjuvant systemic therapy planning.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when work required is substantially greater than typical for the procedure, documented with rationale and time/complexity.
`23`	Unusual anesthesia	Use when general anesthesia is medically necessary for a procedure normally done without it, with documentation.
`52`	Reduced services	Use when a service is partially reduced or not completed as originally planned, with explanation.
`53`	Discontinued procedure	Use when procedure is started but discontinued due to extenuating circumstances or patient decision.
`54`	Surgical care only	Use to indicate the surgeon provided only the surgical portion; postoperative care transferred to another practitioner.
`55`	Postoperative management only	Use when practitioner provides only postoperative care following a procedure performed by another.
`56`	Preoperative management only	Use when practitioner provides only preoperative evaluation and management.
`62`	Two surgeons	Use when two surgeons work together as primary surgeons performing distinct operative work.
`AS`	Ambulatory surgical center (facility)	Use to indicate the service was furnished in an ASC (facility-level modifier).
`QK`	Medical direction of 2-4 services	Use when a physician medically directs a qualified anesthesia provider for multiple cases.

Taxonomy Code	Specialty	Notes
207N00000X	Dermatology	Dermatologists perform diagnostic biopsies and some excisions for melanoma recurrence.
2086S0120X	Surgical Oncology	Surgical oncologists perform wide local excision and regional lymphadenectomy for recurrent melanoma.
207RH0000X	Plastic Surgery	Reconstructive plastic surgeons perform complex closures and reconstructions after wide excisions.
207L00000X	General Surgery	General surgeons in some centers perform melanoma resections and regional node procedures.
2084P0800X	Medical Oncology	Medical oncologists manage staging, systemic therapy decisions, and adjuvant treatment planning.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C43.7`	Malignant melanoma of lower limb, including hip	Melanoma recurrence on lower extremity requiring re-excision and regional node evaluation.
`C43.5`	Malignant melanoma of trunk	Recurrence on trunk necessitating wide local excision and staging.
`C43.9`	Malignant melanoma, unspecified	Used when melanoma site is not otherwise specified in documentation for recurrent disease.
`C43.4`	Malignant melanoma of scalp and neck	Recurrence in head/neck region with implications for surgical approach and reconstruction.
`C43.3`	Malignant melanoma of other and unspecified parts of face	Facial melanoma recurrence requiring specialized surgical management.
`C79.31`	Secondary malignant neoplasm of brain	Included when distant metastasis is identified during staging of recurrent melanoma.
`C77.9`	Secondary and unspecified malignant neoplasm of lymph nodes	Relevant when regional nodal metastasis is identified in recurrent melanoma patients.
`D03.9`	Melanoma in situ, unspecified	Relevant for localized recurrent disease noted as in situ on pathology, affecting management decisions.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`11102`	Tangential biopsy of skin (single lesion)	Used for diagnostic biopsy of a suspicious recurrent melanoma lesion in clinic.
`11606`	Excision, malignant lesion including margins, trunk/arms/legs; excised diameter 1.1 to 2.0 cm	Used for wide local excision of recurrent cutaneous melanoma when lesion size fits code criteria.
`38724`	Sentinel lymph node biopsy, including injection procedure when performed	Performed for regional staging when recurrence suggests possible nodal involvement.
`19301`	Partial mastectomy (for chest wall melanoma resections involving breast tissue)	Applied when recurrent melanoma on the chest wall involves breast tissue requiring partial mastectomy techniques.
`88305`	Level IV surgical pathology, gross and microscopic examination	Typical pathology CPT for evaluation of excised melanoma specimens and margins.