Summary & Overview
HCPCS M1242: Patient Nonresponse to Patient-Centeredness Question
HCPCS Level II code M1242 documents a patient nonresponse to a patient-centered question about whether the provider and care team understood what is important to the patient’s life. As a structured way to record nonresponse, the code supports standardized collection of patient experience data and helps distinguish unavailable or incomplete patient-reported information from negative or neutral responses. Nationally, consistent use of such codes matters for quality measurement, care planning, and aggregating patient experience metrics across outpatient and ambulatory care settings.
Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of what the code represents, the clinical contexts and sites where it is most likely used, and what to expect in terms of reporting gaps when patients do not answer patient-experience items. The publication outlines benchmarks and reporting considerations where available, notes common billing modifiers when present in the input, and identifies where input data are not provided. This material is intended for health policy analysts, billing managers, and quality measurement leads seeking a national-level briefing on how M1242 functions in documentation and reporting workflows.
Billing Code Overview
HCPCS Level II code M1242 indicates that the patient did not respond to the question of whether they felt this provider and team understood what is important to them in their life. This entry documents a nonresponse to a patient-reported experience or patient-centeredness question.
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Service type: Patient experience assessment / patient-reported outcome attempt
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Typical site of service: Ambulatory clinic, outpatient behavioral health or primary care settings where patient experience or care planning conversations occur
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient scenario involves an adult outpatient or home health patient enrolled in a value-based care program or patient experience survey where standardized patient-reported measures are collected. The patient is asked the question, “I felt this provider and team understood what is important to me in my life.” During a routine visit (primary care, geriatrics, palliative care, behavioral health, or home health nurse visit), the patient does not respond — for example, due to cognitive impairment, acute illness, hearing impairment, language barrier without interpreter present, or refusal to answer. The clinical workflow documents the attempt to ask the question, the patient’s non-response, and any mitigating circumstances (time/date, staff present, interpreter availability, patient cognitive status). Typical sites of service are outpatient clinic, home health, skilled nursing facility, or inpatient ward when patient experience measures are collected. The encounter note records the patient-reported outcome item administration, the lack of response, and any follow-up plan or reason why the item could not be answered.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when substantially greater work is required to obtain or attempt patient-reported information due to complexity (e.g., repeated attempts, extensive explanation) that is well documented. |