M1149 Neck PROM — HCPCS Reimbursement & Policy | OpenPayer

Summary & Overview

HCPCS M1149: Neck PROM Not Completed Due to Patient Barriers

HCPCS Level II code M1149 documents situations when a patient cannot complete the neck passive range-of-motion assessment (neck fs prom) at initial evaluation or discharge because of barriers such as blindness, illiteracy, severe cognitive incapacity, or language incompatibility, and no adequate proxy is available. Nationally, this code matters because it records nonclinical reasons for incomplete functional assessments, affecting quality measurement, documentation completeness, and encounter-level reporting. Payers commonly examined in analyses include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will learn what this code represents clinically, which settings and service types typically use it, and how its presence can influence documentation and reporting workflows. The publication provides benchmarks where available, discusses relevant policy and billing implications, and outlines clinical context for use of the code. Data elements not provided in the source input are noted as unavailable. The content is designed for a national audience of clinicians, coding professionals, and policy analysts seeking clear guidance on the purpose and application of M1149 in administrative records.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareM1149HCPCS Level IIneck range of motionphysical therapyfunctional assessmentdocumentationbillingpatient barriers

Billing Code Overview

HCPCS Level II code M1149 indicates that a patient was unable to complete the neck flexion/extension passive range of motion (neck fs prom) at the initial evaluation and/or at discharge because of blindness, illiteracy, severe mental incapacity, or language incompatibility, and that an adequate proxy was not available to assist or provide the required information or participation. This code is used to document circumstances in which the specified neck range-of-motion assessment could not be performed due to patient-level barriers rather than clinical contraindication.

Service type: Functional assessment / physical therapy evaluation component involving neck passive range-of-motion testing
Typical site of service: Outpatient clinic or therapy setting where physical or occupational therapy evaluations are performed

Clinical & Coding Specifications

Clinical Context

A patient is scheduled for an initial outpatient physical therapy evaluation following a cervical spine injury. At the time of the evaluation the therapist attempts to measure neck active and passive range of motion for the cervical spine but is unable to complete the neck full shoulder (fs) passive range of motion (PROM) assessment because the patient is blind and cannot follow visual demonstration, illiterate and unable to read written instructions, has severe cognitive impairment that prevents reliable participation, or speaks a language for which no competent interpreter or adequate proxy is available. The inability to complete the neck PROM occurs either at the initial evaluation or at discharge, and the clinician documents the limiting factor, attempts made to obtain an adequate proxy or interpreter, and any alternative assessment methods attempted (eg, caregiver report, observational assessment). Typical workflow: referral → therapist review of history and prior imaging → attempt standardized neck PROM testing → documentation of inability to complete testing with reason and time/date → use of alternative functional measures as appropriate → billing with M1149 and applicable modifiers per payer rules.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when work required to document inability to complete neck PROM is substantially greater than typical (extensive coordination, translation efforts, complex documentation).

HCPCS Level II M1292: Frailty with Advanced Illness in Patients 66+

HCPCS-M1331-RE-EVALUATION-WITHIN-8-WEEKS

HCPCS M1331: Re-evaluation Within Eight Weeks

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

HCPCS Level II M1342: Patients Who Died During Performance Period

HCPCS-M1466-LUMBAR-FUSION-WITH-DISCECTOMY-LAMINECTOMY

HCPCS Level II M1466: Lumbar Fusion with Discectomy/Laminectomy

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

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

HCPCS-M1441-INITIAL-SLEEP-APNEA-ENCOUNTER

HCPCS M1441: Initial Encounter for Sleep Apnea

HCPCS-M1448-PERSONALITY-DISORDER-DIAGNOSIS-MEASURE

HCPCS M1448: Personality Disorder Diagnosis for Measurement

HCPCS-M1267-KIDNEY-TRANSPLANT-WAITLIST-INACTIVE-STATUS

HCPCS Level II M1267: Kidney/Kidney-Pancreas Transplant Waitlist Inactive Status

HCPCS-M1306-ANAPHYLAXIS-PNEUMOCOCCAL-VACCINE-HISTORY

HCPCS Level II M1306: Anaphylaxis Due to Pneumococcal Vaccine

HCPCS-M1250-PATIENT-FELT-HEARD-UNDERSTOOD

HCPCS M1250: Patient Felt Heard and Understood by Provider

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Taxonomy Code	Specialty	Notes
`225100000X`	Physical Therapist	Primary clinician performing neck ROM assessment and documentation of inability to complete PROM.
`225500000X`	Occupational Therapist	May perform neck ROM assessments in functional context when PT unavailable.
`208000000X`	Physical Medicine & Rehabilitation Physician	Oversees rehabilitation care and documents medical necessity for alternative assessment strategies.
`310400000X`	Ophthalmology	May be involved when blindness is a limiting factor in assessment and consultation is required.
`261QG0400X`	Language Interpretation Services	Professional interpreters are engaged when language incompatibility is present; taxonomy identifies interpreter services rather than a treating clinician.

ICD-10 Code	Description	Clinical Relevance
Data not available in the input.	Data not available in the input.	Data not available in the input.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`97161`	Physical therapy evaluation: low complexity, typically 20 minutes	Often performed as the initial PT evaluation when neck PROM is attempted; documents inability to complete portions of the assessment.
`97162`	Physical therapy evaluation: moderate complexity, typically 30 minutes	Used when the evaluation requires moderate complexity decision making and multiple body regions are assessed alongside the neck.
`97163`	Physical therapy evaluation: high complexity, typically 45 minutes	Used when the evaluation is high complexity (comorbidities, significant coordination) and documentation supports inability to complete neck PROM.
`97110`	Therapeutic exercises to develop strength and endurance, range of motion and flexibility	Commonly performed after evaluation when treatment proceeds despite incomplete baseline PROM documentation; used for neck therapeutic strengthening and ROM interventions.
`97112`	Neuromuscular reeducation of movement, balance, coordination	May be used when functional alternatives to PROM assessment are provided due to inability to complete standard testing.
`99499`	Unlisted evaluation and management service	Rarely used for non-standard documentation activities when no specific code captures extensive coordination for proxies, interpreters, or atypical evaluation circumstances.

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