Summary & Overview
HCPCS M1250: Patient Felt Heard and Understood by Provider
HCPCS Level II code M1250 indicates that a patient responded "completely true" to the statement that they felt heard and understood by their provider and care team. As a patient-reported experience measure, this code documents a high level of patient-perceived communication and relational quality, which can inform quality reporting and patient experience programs nationally. Its relevance extends across ambulatory and outpatient care settings where patient surveys are used to assess provider performance and patient-centered care.
Key payers addressed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find national context on how this type of patient experience measure is used in clinical settings, typical sites of service for capture, and what benchmarks and policy developments are typically associated with patient-reported experience codes. The publication outlines how M1250 is applied in documentation, its role in quality measurement and reporting, and the operational considerations for capturing and coding patient experience responses. Data not available in the input will be noted where applicable.
Billing Code Overview
HCPCS Level II code M1250 describes a patient-reported experience item: the patient responded as "completely true" to the statement that they felt heard and understood by this provider and team. This code captures a positive patient experience measure rather than a specific clinical procedure.
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Service type: Patient-reported experience measure / patient satisfaction assessment
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Typical site of service: Outpatient clinic or ambulatory care settings where patient experience surveys or assessments are administered
Clinical & Coding Specifications
Clinical Context
A typical patient scenario involves an adult or pediatric patient who recently completed an outpatient or ambulatory visit with a behavioral health, primary care, or specialty clinic and completed a standardized patient-experience questionnaire. The billing code M1250 documents the patient response that the statement “I felt heard and understood by this provider and team” was rated as "completely true."
In clinical workflow, the front-desk or medical assistant provides the patient-experience survey (paper or electronic) at check-out or via a secure portal. Responses are entered into the electronic health record (EHR) or a third-party patient-experience platform. A clinician or quality staff member reviews aggregated results for quality reporting, value-based care programs, and patient satisfaction initiatives. The encounter generating the survey is typically an evaluation and management visit, behavioral health visit, or other ambulatory service where communication and shared decision-making are relevant to care quality. Typical sites of service include outpatient clinics, physician offices, community health centers, and ambulatory surgery centers when perioperative communication is assessed.
A realistic patient example: a 52-year-old female with hypertension and type 2 diabetes attends a routine follow-up with her primary care provider. After the visit, she completes the patient-experience questionnaire and selects "completely true" for the item asking whether she felt heard and understood by the provider and care team. The practice records M1250 for quality measurement and reporting purposes linked to that encounter.
Coding Specifications
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