Summary & Overview
HCPCS Level II M1245: Patient-Reported Provider Saw Me as a Person
HCPCS Level II code M1245 denotes a patient-reported response indicating less-than-complete agreement with the statement that the provider and team saw the patient as a person rather than solely as a medical problem. As a measure of patient experience and person-centeredness, this code signals potential concerns in provider-patient relationships and patient satisfaction that can influence quality reporting and value-based payment models nationwide. Key payers in the national context include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will learn what the code represents clinically and operationally, typical settings where it is captured, and how it fits into patient experience measurement frameworks. The publication outlines benchmarks and reporting contexts where available, summarizes relevant policy and payer engagement implications, and provides clinical context about why person-centered communication is tracked. Data elements not provided in the input—such as associated taxonomies, ICD-10 diagnoses, and related codes—are noted as unavailable. This summary is intended to help administrators, coders, and policy stakeholders understand the purpose of M1245, its role in patient experience reporting, and where to look for additional operational or payer-specific guidance.
Billing Code Overview
HCPCS Level II code M1245 indicates that a patient provided a response other than "completely true" to the survey item assessing whether the provider and care team "saw me as a person, not just someone with a medical problem." This code captures a patient-reported experience related to perceived person-centeredness of care.
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Service type: Patient experience assessment / patient-reported outcome measure
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Typical site of service: Ambulatory clinic or outpatient care setting where patient experience surveys are collected
Clinical & Coding Specifications
Clinical Context
A patient completes a standardized patient experience survey after an outpatient primary care or specialty visit and selects a response other than "completely true" to the item asking whether the provider and care team "saw me as a person, not just someone with a medical problem." This triggers documentation and optional follow-up processes in the clinic. Typical workflow: upon receipt of the survey (electronic or paper), the clinic coordinator flags the chart and routes it to the clinician or patient experience team. The clinician reviews the patient’s comments in the electronic health record, documents acknowledgement in the visit note or an outreach message, and may schedule a brief telephone or portal-based follow-up to address concerns. The service is non-procedural, patient-reported, and typically occurs in ambulatory settings such as a primary care clinic, specialty outpatient clinic (e.g., cardiology, oncology), or hospital-based outpatient department. Typical patient scenario: a 58-year-old patient with multiple chronic conditions completes a post-visit survey indicating they felt the team focused only on disease metrics and not on their personal goals; the clinician documents a response and arranges a follow-up phone call to acknowledge the concern and discuss care priorities. The site of service is outpatient ambulatory clinic or hospital outpatient department; the service type is patient experience survey response documentation and related patient outreach.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services |