HCPCS M1340: 12-item WHODAS 2.0 or SDS Index Assessment - OpenPayer

Summary & Overview

HCPCS M1340: 12-item WHODAS 2.0 or SDS Index Assessment

HCPCS Level II code M1340 denotes an index assessment completed with the 12-item WHODAS 2.0 or the Sheehan Disability Scale (SDS) during the denominator identification period. This code captures structured measurement of functional impairment and disability that supports quality measurement, population health management, and care planning across behavioral health and general medical settings. Nationally, use of standardized disability assessments is increasingly important for value-based care programs and quality reporting frameworks.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of what the code represents, expected sites of service, and the clinical context for administering a 12-item WHODAS 2.0 or SDS assessment. The publication summarizes common billing considerations, typical modifiers associated with this service, and areas where additional documentation supports quality measurement. It also outlines what information is available and notes where input data are not provided.

This summary is intended for clinicians, coding and billing staff, and policy analysts who need a clear national-level reference for HCPCS Level II code M1340, how it maps to assessment workflows, and why capture of standardized functional measures matters for quality and population health initiatives.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareM1340HCPCS Level IIWHODAS 2.0Sheehan Disability Scalefunctional assessmentbehavioral healthquality measurementoutpatient assessment

Billing Code Overview

HCPCS Level II code M1340 represents an index assessment completed using the 12-item WHODAS 2.0 or SDS during the denominator identification period. The service is an assessment/measurement of functional status and disability using standardized 12-item instruments (WHODAS 2.0 or Sheehan Disability Scale).

Service Type: Assessment / Screening

Typical Site of Service: Outpatient behavioral health or primary care clinic

Data not available in the input for associated taxonomies, ICD-10 diagnoses, related codes, and service line.

Clinical & Coding Specifications

Clinical Context

A 48-year-old patient with chronic major depressive disorder presents to an outpatient behavioral health clinic for a baseline functional assessment as part of enrollment in a measurement-based care program. The clinician administers the 12-item WHODAS 2.0 during the denominator identification period to quantify disability across domains (cognition, mobility, self-care, getting along, life activities, participation). The assessment is completed by interview in the clinic and scored in the electronic health record. Results are used to document baseline functioning, guide treatment planning (psychotherapy and medication management), and satisfy quality reporting requirements tied to the billed service M1340. Typical workflow: intake or scheduled visit → informed consent for standardized assessment → administration of the WHODAS 2.0 12-item instrument (clinician- or patient-completed) → scoring and documentation of date/time, rater, and score → linkage of assessment to the encounter and submission of M1340 for the denominator period. Typical site of service is outpatient behavioral health clinics, community mental health centers, primary care behavioral health integration settings, or telehealth visits where structured functional assessments are completed.

Coding Specifications

Modifier	Description	When to Use
`22`

HCPCS Level II M1406: Patients Who Leave Practice During Follow-Up

HCPCS-M1439-OCULAR-CONDITIONS-IMPACTING-VISUAL-OUTCOME-OF-SURGERY

HCPCS M1439: Significant Ocular Conditions Affecting Surgical Visual Outcome

HCPCS-M1371-GLYCEMIC-STATUS-ASSESSMENT-HBA1C-LESS-THAN-7

HCPCS M1371: Glycemic Status Assessment, HbA1c/GMI < 7.0%

HCPCS-M1185-IMMUNE-CHECKPOINT-INHIBITOR-THERAPY-NOT-HELD-OR-STEROIDS-NOT-DOCUMENTED

HCPCS M1185: Documentation of Immune Checkpoint Inhibitor/Corticosteroid Management Not Performed

HCPCS-M1475-HUNTINGTONS-DISEASE-CARE

HCPCS Level II M1475: Huntington's Disease Care

HCPCS-M1307-PALLIATIVE-HOSPICE-CARE-DOCUMENTATION

HCPCS M1307: Documentation of Palliative or Hospice Care

HCPCS-M1434-ORAL-CHEMOTHERAPY-STATUS-POST-ENCOUNTER

HCPCS M1434: Patient on Oral Chemotherapy Near Encounter

HCPCS-M1153-OSTEOPOROSIS-DIAGNOSIS-ENCOUNTER

HCPCS M1153: Patient with Osteoporosis on Date of Encounter

HCPCS-M1455-REPLACED-REVISED-DEVICE-COMPONENT

HCPCS Level II M1455: Replacement or Revision of Device Component

HCPCS-M1174-HERPES-ZOSTER-RECOMBINANT-VACCINE-SERIES-COMPLETION

HCPCS M1174: Herpes Zoster Recombinant Vaccine Series Completion

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Taxonomy Code	Specialty	Notes
`103K00000X`	Clinical Social Worker	Common clinician to administer and interpret WHODAS for behavioral health functional assessment.
`207Q00000X`	Psychiatry & Neurology	Psychiatrists frequently order, review, and use WHODAS results in treatment planning.
`2084P0800X`	Behavioral Health (Psychologist)	Psychologists administer standardized functional assessments and interpret results.
`363L00000X`	Nurse Practitioner - Mental Health	Psychiatric nurse practitioners perform assessments and document for billing.
`368000000X`	Physician Assistant - Psychiatry	PAs in behavioral health settings may administer and bill for standardized assessments.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`F32.9`	Major depressive disorder, single episode, unspecified	Depression commonly requires functional assessment with WHODAS to document impact on daily functioning.
`F33.9`	Major depressive disorder, recurrent, unspecified	Recurrent depression patients often have WHODAS used to track functional change over time.
`F41.1`	Generalized anxiety disorder	Anxiety disorders can impair functioning; WHODAS documents degree of disability across domains.
`F43.10`	Post-traumatic stress disorder, unspecified	PTSD frequently affects social and occupational functioning captured by WHODAS domains.
`F07.81`	Postconcussional syndrome	Cognitive and functional limitations after brain injury are assessed with WHODAS for rehabilitation planning.
`G31.84`	Mild cognitive impairment, so stated	Cognitive impairment assessment benefits from WHODAS to quantify functional limitations.
`Z13.89`	Encounter for screening for other disorder	Encounters focused on screening and functional assessment may use WHODAS as part of evaluation.
`R53.83`	Other fatigue	Symptoms such as fatigue affecting daily activities can be documented by WHODAS to show impact.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`96127`	Brief emotional/behavioral assessment (e.g., depression inventory, ADHD scale), scoring and documentation, per standardized instrument	Often performed alongside `M1340` for symptom-specific brief screening and scoring in the same visit.
`96136`	Psychological or neuropsychological test administration and scoring by physician or other qualified health care professional, first 30 minutes	Used when more extensive testing or administration time is required beyond the brief WHODAS interview and scoring.
`96138`	Psychological or neuropsychological test administration and scoring, each additional 30 minutes	Used when test administration extends beyond the initial 30 minutes for comprehensive functional assessment.
`99420`	Administration and interpretation of health risk assessment instrument (time not otherwise classified)	May be used in some workflows for broader health risk assessments that include functional status evaluation.
`G0444`	Annual depression screening, 15 minutes	Common preventive or monitoring code used in primary care visits where `M1340` may also be completed to document functional impact.

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