Summary & Overview
HCPCS Level II M1047: Oxford Knee Score Patient-Reported Outcome
HCPCS Level II code M1047 corresponds to recording the Oxford Knee Score (OKS) patient-reported outcome measured within three months before knee surgery and again at one year (9–15 months) after surgery. Nationally, standardized collection of PROs such as the OKS supports quality measurement, comparative outcomes assessment, and value-based contracting across orthopedic practices and health systems. Use of M1047 signals structured capture of knee-specific function and pain outcomes that matter for patient-centered care and longitudinal surgical effectiveness evaluation.
Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical context for M1047, the expected service setting and workflow implications, and what benchmarks and policy elements are typically relevant when PRO-based measures are submitted for performance reporting and contract compliance. The publication also outlines how M1047 fits into postoperative outcome tracking, common reporting windows, and considerations for aggregated outcome measurement. Data not available in the input where specific payer coverage rules, modifiers, taxonomies, or related billing codes would normally be listed.
Billing Code Overview
HCPCS Level II code M1047 documents that functional status was measured by the Oxford Knee Score (OKS) patient-reported outcome tool within three months preoperatively and at one year (9 to 15 months) postoperatively. The service type is patient-reported outcome assessment for knee function. The typical site of service is orthopedic clinic or surgical practice, including preoperative consultations and postoperative follow-up visits.
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Clinical & Coding Specifications
Clinical Context
A 67-year-old patient with end-stage osteoarthritis of the knee is scheduled for primary total knee arthroplasty. Preoperative assessment includes patient-reported outcome measurement: the Oxford Knee Score (OKS) completed within three months before surgery to document baseline function and pain. Standard perioperative care proceeds with surgery under regional or general anesthesia and routine inpatient or ambulatory recovery depending on comorbidities. At a one-year postoperative follow-up visit (9 to 15 months after surgery), the patient completes the OKS again to measure functional recovery and compare to baseline. Collected OKS scores are documented in the medical record and used for quality reporting and outcomes assessment. Typical workflow: preoperative clinic visit with OKS administration and scoring, operative episode (orthopedic surgeon, anesthesiology, nursing), postoperative follow-up visits at routine intervals, and formal one-year outcome visit where the OKS is administered by clinic staff or via validated electronic patient-reported outcome platform.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable evaluation and management service by the same physician on the day of a procedure | Use when a distinct E/M visit is provided the same day as a procedure related to surgical decision-making or acute problem management |