M1393 HCPCS: Reimbursement & Policy Benchmarks | OpenPayer

Summary & Overview

HCPCS M1393: Nonrecurrent Melanoma Status

HCPCS Level II code M1393 denotes patients who were not diagnosed with recurrent melanoma during the current performance period. The code is used to classify and report patient status for melanoma surveillance and quality reporting programs, supporting measurement of recurrence-free cohorts and related outcome metrics. Nationally, clear identification of nonrecurrent status informs quality assessment, performance measurement, and care coordination across oncology and dermatology services.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the clinical context for M1393, typical service settings where the code is applied, and what its use signifies for melanoma surveillance and reporting. The publication also outlines typical benchmarks, common billing modifiers, and programmatic considerations relevant to payers and providers. Where input data are incomplete, the text indicates "Data not available in the input." The aim is to provide a concise reference for clinicians, billing professionals, and policy analysts seeking to understand how M1393 is used in national reporting and care pathways for patients without recurrent melanoma.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareM1393HCPCS Level IImelanoma surveillanceoncologydermatologyrecurrence statusquality measurementoutcome reporting

Billing Code Overview

HCPCS Level II code M1393 designates patients who were not diagnosed with recurrent melanoma during the current performance period. This code pertains to assessment and reporting of melanoma recurrence status and is used to identify patients without documented recurrent disease in the defined performance window.

Service type: Surveillance and outcome assessment related to melanoma recurrence status
Typical site of service: Oncology clinic, dermatology clinic, outpatient surgical follow-up, or ambulatory care settings

Clinical & Coding Specifications

Clinical Context

A typical patient is an adult with a prior history of primary cutaneous melanoma who presents for routine surveillance during the current performance period. The patient has no clinical signs, symptoms, or imaging findings suggestive of recurrent melanoma; pathology review and clinical examination do not identify new suspicious lesions. The clinical workflow includes: pre-visit chart review of prior melanoma staging and treatment, focused skin and lymph node physical examination, review of interval history (new lumps, weight loss, or persistent symptoms), coordination of surveillance imaging if indicated by prior stage (for example chest CT for stage II/III per institutional protocol), and documentation that there is no recurrence. If no recurrence is found, the billing entry M1393 is used to indicate the patient was not diagnosed with recurrent melanoma during the performance period. Typical sites of service are outpatient dermatology, surgical oncology, medical oncology, or survivorship clinics. A realistic scenario: a 58-year-old male five years post wide local excision and sentinel lymph node biopsy for stage II melanoma attends a scheduled surveillance visit; exam and review of interval studies show no evidence of recurrence and the clinician documents no recurrent melanoma for the current performance period.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when work required is substantially greater than typically required (document rationale).

HCPCS Level II M1470: Documentation of Medical Reason for Not Administering Hepatitis B Vaccine

HCPCS-M1477-DIAGNOSIS-DELIRIUM

HCPCS Level II M1477: Diagnosis of Delirium

HCPCS-M1342-PATIENTS-WHO-DIED-DURING-PERFORMANCE-PERIOD

HCPCS Level II M1342: Patients Who Died During Performance Period

HCPCS-M1306-ANAPHYLAXIS-PNEUMOCOCCAL-VACCINE-HISTORY

HCPCS Level II M1306: Anaphylaxis Due to Pneumococcal Vaccine

HCPCS-M1174-HERPES-ZOSTER-RECOMBINANT-VACCINE-SERIES-COMPLETION

HCPCS M1174: Herpes Zoster Recombinant Vaccine Series Completion

HCPCS-M1400-PATIENT-DEATH-DURING-FOLLOW-UP

HCPCS M1400: Patients Who Died During Follow-Up

HCPCS-M1202-NOT-PRESCRIBING-ACE-INHIBITOR-OR-ARB-REASON-DOCUMENTED

HCPCS M1202: Documentation of Reason for Not Prescribing ACE Inhibitor or ARB Therapy

HCPCS-M1418-COVID19-VACCINATION-MEDICAL-CONTRAINDICATION

HCPCS M1418: COVID-19 Vaccination Not Up to Date Due to Medical Contraindication

HCPCS-M1178-DOCUMENTATION-PNEUMOCOCCAL-VACCINE-EXEMPTION

HCPCS M1178: Documentation of Medical Reason Not to Administer Pneumococcal Vaccine

HCPCS-M1403-PROMIS-BASELINE-AND-FOLLOW-UP-SURVEYS

HCPCS M1403: PROMIS Baseline and Follow-Up Survey Documentation

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Taxonomy Code	Specialty	Notes
`207P00000X`	Dermatology	Dermatologists provide surveillance skin exams and biopsy of suspicious lesions.
`208M00000X`	General Surgery / Surgical Oncology	Surgical oncologists perform excision and sentinel node procedures; provide postoperative surveillance.
`2084P0800X`	Medical Oncology	Medical oncologists manage systemic surveillance and coordinate imaging and follow-up for higher-stage disease.
`261QP2400X`	Physician Assistant	PAs frequently conduct follow-up visits and surveillance exams under physician delegation.
`363A00000X`	Nurse Practitioner	NPs perform survivorship visits and documentation of no recurrence in many clinics.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`Z85.820`	Personal history of malignant melanoma of skin	Common coding for a patient with prior melanoma under surveillance; supports use of `M1393` when no recurrence is diagnosed.
`C43.9`	Malignant melanoma of skin, unspecified	Used when active melanoma is present; not applicable when `M1393` documents no recurrence but relevant in differential.
`Z90.710`	Acquired absence of right upper limb (example of post-treatment status)	Example of post-treatment status codes that may coexist in long-term survivors; documents functional status in follow-up.
`Z09`	Encounter for follow-up examination after completed treatment for conditions other than malignant neoplasm	Used for routine post-treatment follow-up visits; similar follow-up purpose as visits billed with `M1393`.
`Z51.11`	Encounter for antineoplastic chemotherapy	May appear in patient history if systemic therapy was part of prior melanoma treatment; relevant to surveillance planning.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`11102`	Tangential biopsy of skin (e.g., shave), single lesion	Performed if a new suspicious skin lesion is identified during surveillance before confirming absence of recurrence.
`11646`	Excision, malignant lesion including margins, trunk/arms/legs; excised diameter over 4.0 cm	Used if biopsy or exam converts surveillance visit into therapeutic excision for recurrent or new primary melanoma.
`38792`	Sentinel lymph node biopsy (including mapping)	Performed when clinical suspicion or staging requires nodal evaluation beyond routine surveillance.
`96372`	Therapeutic, prophylactic, or diagnostic injection (e.g., intralesional)	May be used for supportive treatments encountered during follow-up visit (for example, steroid injection for scar-related symptoms).
`99213`	Office or other outpatient visit for evaluation and management of an established patient, low to moderate complexity	Common E/M level used for routine surveillance visit where no recurrence is found; documents interval history and focused exam.

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