M1248 HCPCS — Reimbursement & Policy Benchmarks | OpenPayer

Summary & Overview

HCPCS Level II M1248: Patient-Reported Person-Centered Care

HCPCS Level II code M1248 denotes a patient-reported experience measure indicating the patient answered "completely true" to feeling that the provider and team saw them as a person rather than solely a medical problem. This metric captures person-centeredness, a core dimension of care quality tied to patient satisfaction, trust, and engagement. Nationally, such experience measures inform value-based purchasing, quality reporting, and patient-centered initiatives across public and private payers.

Key payers addressed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare and Medicare. Readers will find a concise overview of the code’s clinical and operational meaning, typical sites of service where it is collected, and the role this measure plays in quality programs. The publication summarizes benchmarking considerations and policy context relevant to measurement and reporting, highlights implications for ambulatory care workflows, and notes where input data are unavailable.

This summary is intended for administrators, quality leads, and policy analysts seeking a clear national-level briefing on the purpose and use of M1248 in patient experience measurement.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareM1248HCPCS Level IIpatient experienceperson-centered carepatient-reported outcomeambulatory carequality measurementpatient satisfaction

Billing Code Overview

HCPCS Level II code M1248 captures a patient-reported experience measure in which the patient responded "completely true" to the statement that the provider and care team "saw me as a person, not just someone with a medical problem." This code reflects a patient perception of personalized, person-centered care.

Service type: Patient-reported experience measure (PREM) or patient experience assessment
Typical site of service: Ambulatory care settings, including outpatient clinics and physician offices, where patient experience surveys or encounter-based assessments are collected

Clinical & Coding Specifications

Clinical Context

A middle-aged patient attends a primary care or outpatient behavioral health visit and completes a patient experience questionnaire. The patient selects “completely true” in response to the item asking whether the provider and team saw them as a person and not just someone with a medical problem. The encounter is not a procedure but a documented patient-reported experience measure tied to care quality and patient-centeredness. Typical workflow: front-desk or rooming staff provide the questionnaire (paper or electronic); clinical staff review responses and flag notable items; the provider discusses patient concerns during the visit; responses are recorded in the medical record and may be abstracted for quality reporting or billed when applicable under the specific HCPCS Level II code.

Typical site of service: outpatient clinic, primary care office, behavioral health clinic, patient-centered medical home, or community health center.

Typical patient scenario: a patient with chronic illness (for example, diabetes or chronic pain) visits for routine follow-up. During check-in they complete a standardized patient experience survey. The patient endorses that the care team recognized their personal context and values. The clinical team documents the response in the chart to support patient-centered care metrics and potential quality reporting tied to M1248.

Common stakeholders: primary care physicians, nurse practitioners, physician assistants, behavioral health clinicians, medical assistants, clinic managers, quality improvement staff.

Coding Specifications

Modifier table

Modifier	Description

HCPCS M1216: No Spirometry Results Documented for Airflow Obstruction

HCPCS-M1430-RETINAL-EXAM-NO-RETINOPATHY-BOTH-EYES-SEVERITY-DOCUMENTED

HCPCS M1430: Retinal Exam, No Retinopathy in Both Eyes with Severity Documented

HCPCS-M1488-DEMENTIA-DIAGNOSIS-FLAG

HCPCS M1488: Dementia Diagnosis in Evaluation Period

HCPCS-M1462-HEAD-IMAGING-CLINICAL-INDICATIONS

HCPCS M1462: Head Imaging for Clinical Indications

HCPCS-M1341-MISSED-FOLLOW-UP-ASSESSMENT-30-180-DAYS

HCPCS M1341: Missed Follow-Up Assessment Within 30–180 Days

HCPCS-M1298-PREGNANCY-DOCUMENTATION-MEASUREMENT-PERIOD

HCPCS Level II M1298: Documentation of Patient Pregnancy

HCPCS-M1364-ASCVD-10-YEAR-RISK-20-PERCENT-OR-GREATER

HCPCS Level II M1364: 10-Year ASCVD Risk Score ≥20%

HCPCS-M1331-RE-EVALUATION-WITHIN-8-WEEKS

HCPCS M1331: Re-evaluation Within Eight Weeks

HCPCS-M1435-ORAL-CHEMOTHERAPY-PATIENT-STATUS

HCPCS Level II M1435: Patient on Oral Chemotherapy

HCPCS-M1471-MEDICARE-PART-B-HEP-B-VACCINE-COVERAGE-STATUS

HCPCS M1471: Medicare Part B Hepatitis B Vaccine Coverage Status

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Taxonomy Code	Specialty	Notes
`208D00000X`	Family Medicine	Common primary care clinicians who administer patient experience assessments in outpatient settings.
`207Q00000X`	Internal Medicine	Frequently documents patient-reported experience in chronic disease follow-up visits.
`363L00000X`	Clinical Social Worker	Behavioral health clinicians involved in patient-centered assessments and care planning.
`103T00000X`	Nurse Practitioner	Advanced practice clinicians who often collect and document patient experience measures during visits.
`207R00000X`	Allergy & Immunology (Representative outpatient specialty)	Specialists in outpatient clinics who may capture patient experience metrics as part of care coordination.

ICD-10 Code	Description	Clinical Relevance
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 visit during which patient experience items like `M1248` are collected and documented.
`99406`	Smoking and tobacco use cessation counseling visit, intermediate, greater than 3 minutes up to 10 minutes	Example of a counseling service often delivered in the same visit where patient experience is assessed.
`96127`	Brief emotional/behavioral assessment (e.g., depression inventory) with scoring and documentation, per standardized instrument	Patient-reported measures and brief assessments may be administered alongside the patient experience item documented by `M1248`.
`99495`	Transitional care management services with moderate medical decision complexity, face-to-face within 14 days of discharge	Transitional care encounters frequently include patient experience documentation as part of quality measures.
`G2212`	Visit complexity inherent to evaluation and management associated with primary care services (add-on)	May be reported in conjunction with E/M services when visit complexity and care coordination are higher and patient-centered metrics are documented.

`22`	Increased procedural services	Use when additional work beyond the usual is documented and justifies increased payment for an associated billed service.
`23`	Unusual anesthesia	Use when an otherwise non-anesthetic procedure requires anesthesia for unusual circumstances.
`52`	Reduced services	Use when a service is partially reduced or not completed as originally planned.
`53`	Discontinued procedure	Use when a procedure is started but terminated due to extenuating circumstances.
`54`	Surgical care only	Use when only the surgical care portion is billed and other care is billed separately.
`55`	Postoperative management only	Use when only postoperative care is provided by the billing provider.
`56`	Preoperative management only	Use when only preoperative care is provided by the billing provider.
`62`	Two surgeons	Use when two surgeons work together as primary surgeons on the same procedure.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery	Use when an advanced practice clinician assists at surgery and reporting is required.
`QK`	Medical direction of two, three, or four concurrent anesthesia procedures involving qualified individuals	Use when the reporting anesthesiologist medically directs multiple concurrent anesthesia procedures.
`QX`	Certified registered nurse anesthetist (CRNA) service with medical direction by a physician	Use when CRNA provides anesthesia and physician directs.
`QY`	Medical direction of one certified registered nurse anesthetist by an anesthesiologist	Use when anesthesiologist medically directs one CRNA.
`FX`	Bilateral procedure modifier (facility use)	Use to indicate bilateral procedure in facility billing when applicable.
`FY`	Billed as a single subject procedure (facility)	Use when facility bills a service as single-subject procedure.

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