HCPCS M1246: Patient-Reported Provider Understanding of What Matters - OpenPayer

Summary & Overview

HCPCS M1246: Patient-Reported Provider Understanding of What Matters

HCPCS Level II code M1246 flags a patient-reported response indicating the patient did not rate the provider and care team as "completely true" for understanding what is important in the patient’s life. As a measure of patient experience and person-centered care, this code matters nationally because it captures subjective perceptions that can influence care planning, adherence, satisfaction scores, and quality reporting efforts. Payers commonly addressing patient experience in contracts and quality programs include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.

This publication summarizes the clinical meaning and administrative use of HCPCS Level II code M1246, outlines typical service settings, and highlights what readers can expect: baseline benchmarks where available, implications for inclusion in patient experience measurement, and connections to broader quality reporting and value-based programs. Data not available in the input where specific benchmark values, associated taxonomies, ICD-10 pairings, and related codes would otherwise be presented. The goal is to provide a concise reference describing what this code represents, which payers it pertains to in typical analyses, and the operational context for facilities and practices that collect patient-reported experience data.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareM1246HCPCS Level IIpatient experiencepatient-reported outcomeambulatory carequality measurementperson-centered care

Billing Code Overview

HCPCS Level II code M1246 indicates that a patient provided a response other than "completely true" to the survey item asking whether the provider and care team "understood what is important to me in my life." This code captures a patient-reported experience reflecting perceived gaps in provider understanding of personal values and priorities.

Service type: Patient experience measurement / patient-reported outcome collection
Typical site of service: Ambulatory care settings, including primary care clinics and outpatient specialty practices where patient experience surveys or assessments are administered

Clinical & Coding Specifications

Clinical Context

A 68‑year‑old patient attends a primary care visit focused on chronic disease management and overall care experience assessment. During the visit, the patient completes a standardized patient experience questionnaire that includes the item: whether the provider and team understood what is important to the patient in their life. The patient responds with an option other than "completely true" (for example, "mostly true", "somewhat true", or "not at all true"). The clinical workflow includes collection of the patient-reported survey by medical assistants, review of the response by the primary care provider or care manager, documentation in the electronic health record (EHR), and potential care plan adjustments or referral to behavioral health, social work, or palliative care to address unmet psychosocial needs. Typical site of service is an outpatient primary care clinic or ambulatory care center where patient experience surveys are routinely administered. The service type is a patient-reported experience measure captured and coded for quality reporting and billing purposes. Typical patient scenario: an older adult with multiple chronic conditions (hypertension, diabetes, osteoarthritis) who indicates less-than-complete agreement that the care team understands personal life priorities, prompting further assessment of goals of care and social determinants of health.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when additional work beyond the typical is documented, such as extended counseling about goals of care after the survey response indicates unmet needs.

HCPCS Level II M1281: Blood Pressure Not Documented, Reason Not Given

HCPCS-M1186-HOSPICE-PALLIATIVE-CARE-ORDER-OR-RECEIVING

HCPCS Level II M1186: Hospice or Palliative Care Order/Receiving

HCPCS-M1424-PULMONOLOGY-MIPS-VALUE-PATHWAY

HCPCS M1424: Pulmonology Care MIPS Value Pathway

HCPCS-LEVEL-II-M1255-POSITIVE-PREGNANCY-TEST-NON-OB-VISIT

HCPCS Level II M1255: Positive Pregnancy Test During Non-Obstetric Clinic Visit

HCPCS-M1496-FALL-NO-PLAN-OR-ASSESSMENT-DOCUMENTED

HCPCS M1496: Fall Without Documented Assessment or Care Plan

HCPCS-M1220-DILATED-RETINAL-EXAM-RETINOPATHY

HCPCS M1220: Dilated Retinal Exam with Interpretation for Retinopathy

HCPCS-M1446-PATIENT-DEATH-DURING-MEASURE-PERIOD

HCPCS Level II M1446: Patient Death During Measure Assessment Period

HCPCS-M1464-FOLLOW-UP-DOCUMENTATION-DEFICIENCY

HCPCS Level II M1464: Missing Documentation of Follow-Up Attempts

HCPCS-M1462-HEAD-IMAGING-CLINICAL-INDICATIONS

HCPCS M1462: Head Imaging for Clinical Indications

HCPCS-M1180-IMMUNE-CHECKPOINT-INHIBITOR-THERAPY-MONITORING

HCPCS M1180: Patients on Immune Checkpoint Inhibitor Therapy

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Taxonomy Code	Specialty	Notes
`208000000X`	Family Medicine	Primary care providers who routinely administer patient experience surveys and address care priorities.
`207Q00000X`	Internal Medicine	General internists caring for adults with chronic conditions and assessing patient-centered care.
`363L00000X`	Nurse Practitioner	NPs frequently collect patient-reported experience measures and coordinate follow-up.
`367A00000X`	Physician Assistant	PAs involved in ambulatory visits and documentation of patient experience results.
`208D00000X`	Geriatric Medicine	Specialists managing older adults where goals-of-care alignment is a frequent focus.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`Z71.9`	Counseling, unspecified	Indicates counseling services that may follow when a patient reports care misalignment.
`Z60.0`	Social environment problems, unspecified	Reflects social determinants that can underlie a patient feeling misunderstood by the care team.
`Z63.0`	Problems in relationship with spouse or partner	Psychosocial stressors that can impact patient priorities and care discussions.
`F32.9`	Major depressive disorder, single episode, unspecified	Mood disorders may influence patient experience responses and require assessment.
`R45.82`	Altered mental status, unspecified	Cognitive or communication issues that could affect patient perception of being understood.
`Z66`	Do not resuscitate status	Goals-of-care documentation that may be prompted by identification of misaligned priorities.
`Z13.89`	Encounter for screening for other disorder	Screening or assessment encounters often include patient experience measures.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`96127`	Brief emotional/behavioral assessment (e.g., depression inventory, ADHD scale), per standardized instrument	Often performed alongside patient experience surveys to screen for distress that may explain lower experience ratings.
`99401`	Preventive medicine counseling, 15 minutes	Counseling to address concerns identified by the survey; used when brief counseling is separately reportable.
`99406`	Smoking and tobacco use cessation counseling, intermediate, greater than 3 minutes up to 10 minutes	Potentially related when survey responses trigger behavior‑change counseling referrals.
`99497`	Advance care planning including discussion and completion of advance directives, first 30 minutes	Used when the survey prompts goals-of-care or advance care planning discussions.
`99395`	Periodic comprehensive preventive medicine reevaluation, established patient, 18–39 years	Example of an ambulatory visit code that could include administration of patient experience measures as part of the encounter.

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