HCPCS M1240: Patient Nonresponse to Provider Best-Interests Question - OpenPayer

Summary & Overview

HCPCS M1240: Patient Nonresponse to Provider Best-Interests Question

HCPCS Level II code M1240 denotes that a patient did not respond to the survey question asking whether the provider and care team put the patient's best interests first when making care recommendations. As a patient-experience capture code rather than a clinical procedure, M1240 matters for quality reporting, patient satisfaction tracking, and value-based care programs that incorporate patient-reported measures.

Key payers included in this coverage context are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will learn the clinical context of M1240, how it is used to document nonresponse in patient-experience data collection, and why such nonresponse can affect measurement completeness in quality reporting. The publication covers benchmarks and reporting implications where available, policy considerations tied to patient-reported outcome and experience measures, and operational considerations for capturing survey data across ambulatory and home-based settings. Data not available in the input will be noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareM1240HCPCS Level IIpatient experiencequality reportingpatient-reported measuresoutpatienthome healthsurvey nonresponse

Billing Code Overview

HCPCS Level II code M1240 indicates that the patient did not respond to the question asking whether they felt the provider and care team put their best interests first when making recommendations about their care. This measure captures a lack of patient response to a specific patient-experience question rather than a clinical service or procedure.

Service type: Patient-reported experience measure captured during patient surveys or interviews
Typical site of service: Ambulatory care settings, outpatient clinics, home health visits, or any care environment where patient experience surveys are administered

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A typical patient scenario involves an adult outpatient who completed a clinic visit in which patient experience surveys (such as CAHPS-style questions) were administered verbally or in writing. During the encounter, staff asked the question: “Did you feel this provider and team put your best interests first when making recommendations about your care?” The patient did not respond to that specific question due to reasons such as refusal to answer, language barrier without timely interpreter available, cognitive impairment, acute distress, or interruption before survey completion. The clinical workflow: registration or clinical staff provide the survey; if unanswered, staff document nonresponse and select billing code M1240 to indicate the patient did not respond to that item. This typically occurs in primary care, family medicine, geriatrics, or ambulatory specialty clinics where patient experience measures are collected as part of quality reporting or value-based care programs. Typical site of service: outpatient clinic or ambulatory care center. Typical patient scenario: a 78-year-old patient with mild dementia brought by caregiver to an ambulatory geriatrics visit; during post-visit survey the patient is nonverbal and does not answer the item; staff documents nonresponse and assigns M1240 for the specific survey question.

Coding Specifications

Modifier	Description	When to Use
`22`

HCPCS M1191: Hospice Services During Measurement Period

HCPCS-M1184-DOCUMENTATION-MEDICAL-REASON-NO-CORTICOSTEROID-OR-IMMUNOSUPPRESSANT

HCPCS M1184: Documentation of Medical Reason for Not Prescribing Corticosteroid/Immunosuppressant

HCPCS-M1387-PATIENT-DEATH-DURING-PERFORMANCE-PERIOD

HCPCS Level II M1387: Patient Death During Performance Period

HCPCS-M1444-DELIVERY-BEFORE-39-WEEKS-GESTATION

HCPCS M1444: Delivery Before 39 Weeks of Gestation

HCPCS-M1307-PALLIATIVE-HOSPICE-CARE-DOCUMENTATION

HCPCS M1307: Documentation of Palliative or Hospice Care

HCPCS-M1310-TOBACCO-CESSATION-SCREENING-AND-INTERVENTION

HCPCS Level II M1310: Tobacco Use Screening and Cessation Intervention

HCPCS-M1304-PNEUMOCOCCAL-VACCINE-STATUS-ADULT

HCPCS M1304: Adult Pneumococcal Vaccination Status Not Received

HCPCS-M1199-RENAL-REPLACEMENT-THERAPY-SERVICES

HCPCS M1199: Renal Replacement Therapy Services

HCPCS-M1208-NO-SOCIAL-NEEDS-SCREENING

HCPCS Level II M1208: No Screening for Key Social Needs

HCPCS-M1205-ITCH-SEVERITY-IMPROVEMENT-ASSESSMENT

HCPCS M1205: Itch Severity Improvement Assessment

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Taxonomy Code	Specialty	Notes
`207Q00000X`	Family Medicine	Primary care clinicians who often collect patient experience surveys.
`207R00000X`	Internal Medicine	Internal medicine physicians in ambulatory clinics administering experience measures.
`207V00000X`	Geriatric Medicine	Geriatricians frequently document nonresponse when cognitive impairment prevents answering.
`363A00000X`	Nurse Practitioner	Nurse practitioners who conduct visits and administer surveys in outpatient settings.
`367A00000X`	Physician Assistant	Physician assistants involved in clinic workflows and patient experience data collection.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`F02.80`	Dementia in other diseases classified elsewhere without behavioral disturbance	Cognitive impairment can prevent patient from answering patient experience survey items, leading to use of `M1240`.
`F03.90`	Unspecified dementia, uncomplicated	Common in geriatric clinics where patients may not respond to specific survey questions.
`R41.82`	Altered mental status, unspecified	Acute or chronic altered mental status may cause nonresponse to patient experience items.
`R41.0`	Disorientation, unspecified	Disoriented patients may be unable to answer survey questions.
`Z91.19`	Patient's noncompliance with other medical treatment and regimen	When a patient refuses to answer survey questions, documentation may reference refusal codes in the record alongside `M1240`.
`Z68.1`	Body mass index (BMI) 19.9 or less, adult	Example chronic condition seen in ambulatory care; included as a commonly paired diagnosis in comprehensive visits where surveys are done.
`I10`	Essential (primary) hypertension	Frequently present as comorbidity during visits where patient experience surveys are collected.

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 visit during which patient experience survey items like the `M1240` question are administered or collected.
`99406`	Smoking and tobacco use cessation counseling, intermediate, 3-10 minutes	Example of a counseling service that may occur during the same visit as survey administration; survey nonresponse is documented separately with `M1240`.
`99407`	Smoking and tobacco use cessation counseling, intensive, >10 minutes	Higher-intensity counseling that can coincide with patient experience data collection; `M1240` documents the specific nonresponse item.
`96127`	Brief emotional/behavioral assessment (eg, depression inventory) with scoring and documentation, per standardized instrument	Patient questionnaires and brief assessments often administered alongside experience surveys; nonresponse to an individual experience item is reported with `M1240`.
`99397`	Periodic comprehensive preventive medicine reevaluation, established patient, 65 years and older	Preventive visits in older adults frequently include patient experience surveys; when the patient does not answer the specific item, `M1240` is assigned.
`99483`	Assessment of and care planning for patients with cognitive impairment, requiring an independent historian, etc.	Cognitive assessments often explain nonresponse to experience items; `M1240` documents the nonresponse to the survey question.

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