M1239 HCPCS Reimbursement & Policy Benchmarks

HCPCS Level II code M1239 documents that a patient did not respond to the question asking whether they felt heard and understood by the provider and team. As a patient-experience capture code, M1239 matters nationally as health systems and payers increasingly track experience metrics for quality measurement, patient-centered care assessment, and value-based payment programs. The code signals an absence of evaluative feedback rather than a clinical finding.

Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find context on how M1239 is used in encounter documentation, implications for quality measurement frameworks, and typical settings where the code is applied. The publication outlines benchmarks and reporting considerations when patient responses are missing, summarizes policy-relevant impacts on quality reporting, and clarifies the clinical context for capturing patient experience during outpatient visits or other direct care interactions.

Data not available in the input for associated taxonomies, specific ICD-10 pairings, and related service-line details. The summary emphasizes national relevance for quality measurement and administrative reporting where patient experience metrics are tracked.

Billing Code Overview

HCPCS Level II code M1239 indicates that the patient did not respond to the question of whether they felt heard and understood by this provider and team. This entry captures a patient experience measure where no affirmative or negative response was recorded.

Service type: Patient experience assessment captured during clinical encounter
Typical site of service: Outpatient clinical setting or any direct patient-provider interaction where patient experience questions are administered

Clinical Context

A patient presents to a primary care clinic or outpatient behavioral health setting following a recent visit or ongoing care where team communication and the therapeutic relationship are assessed. The patient is an adult with chronic pain or a complex chronic condition and was asked the standardized question, "Did you feel heard and understood by this provider and team?" The patient did not respond to the question during the visit — either remaining silent, providing an ambiguous nonverbal cue, or declining to answer. Clinical workflow: the medical assistant or nurse administers intake questionnaires, documents the unanswered item, alerts the clinician during the encounter, and the clinician documents attempts to elicit a response and any relevant observations about cognition, hearing, language barrier, emotional state, or distress. If appropriate, trained staff may attempt the question again, use an interpreter, or note reasons for nonresponse (e.g., patient fatigue, acute distress). The encounter note includes the standardized item, the lack of response, contextual factors (hearing impairment, language needs, altered mental status), and any follow-up plans (repeat assessment, referral to behavioral health, or family involvement). Typical site of service: outpatient clinic, primary care office, behavioral health clinic, or telehealth visit.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when work required is substantially greater than typically required for similar encounters due to extensive attempts to obtain patient response or document communication barriers.

Taxonomy Code	Specialty	Notes
207Q00000X	Family Medicine	Primary care clinicians who commonly assess patient experience and communication during routine visits.
207R00000X	Internal Medicine	Internists managing chronic disease who frequently document patient-reported experience measures.
2084P0800X	Psychiatry & Neurology	Behavioral health clinicians assessing patient understanding and therapeutic rapport.
363L00000X	Pain Medicine	Clinicians managing chronic pain where patient engagement and shared decision-making are routinely evaluated.
261QM0800X	Clinical Social Work	Behavioral health and care coordination staff who perform patient experience assessments and documentation.

Related Diagnoses

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
`99213`	Office or other outpatient visit for the evaluation and management of an established patient, typically 15 minutes	Common E/M encounter during which the question of feeling heard is asked and documentation of nonresponse occurs.
`99420`	Administration and interpretation of health risk assessment instrument (e.g., depression screening)	May be used in conjunction when standardized patient experience or behavioral screening instruments are administered and an item is unanswered.
`96127`	Brief emotional/behavioral assessment (e.g., depression screening) with scoring and documentation, per standardized instrument	Used when brief standardized patient-reported measures are completed and an item such as feeling heard is unanswered and documented.
`99406`	Smoking and tobacco use cessation counseling, intermediate, greater than 3 minutes up to 10 minutes	Example of time-based counseling that may occur in the same visit where communication assessment is performed; nonresponse may alter counseling workflow.
`99441`	Telephone evaluation and management service by a physician or other qualified health care professional, 5-10 minutes of medical discussion	Applicable when the standardized question is asked during a telehealth or phone encounter and the patient does not respond.

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Summary & Overview

HCPCS Level II M1239: Patient Did Not Respond to 'Heard and Understood' Question