HCPCS M1344: Missing Baseline or Follow-up Patient Activation Measure - OpenPayer

Summary & Overview

HCPCS M1344: Missing Baseline or Follow-up Patient Activation Measure

HCPCS Level II code M1344 documents patients who did not have a baseline Patient Activation Measure (PAM) score and/or lacked a follow-up PAM score within 4 to 12 months of baseline. Nationally, this code flags gaps in measurement of patient self-management capability, a metric increasingly used in quality programs and care management initiatives. Accurate use of M1344 supports reporting completeness and helps payers and providers identify populations with incomplete activation assessment.

Key payers included in the analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find context on the clinical purpose of the code, typical service settings where the code is used, and what the code signifies for quality reporting. The publication provides benchmarks and policy context where available, describes how M1344 interacts with care management workflows, and summarizes implications for payers and provider documentation.

The content is intended for national audiences involved in coding, quality measurement, care management, and payer contract administration. Data not available in the input will be noted as such in detailed sections.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareM1344HCPCS Level IIpatient activationPAMquality measurementcare managementoutpatientassessment reporting

Billing Code Overview

HCPCS Level II code M1344 describes patients who did not have a baseline PAM score and/or a second score within 4 to 12 months of the baseline PAM score. This code applies to documentation and reporting related to incomplete or missing Patient Activation Measure (PAM) assessments.

Service type: Assessment reporting / quality measure documentation
Typical site of service: Outpatient clinic or ambulatory care settings where PAM assessment is expected as part of care management

Clinical & Coding Specifications

Clinical Context

A 58-year-old patient with type 2 diabetes and multiple chronic conditions is enrolled in a primary care practice diabetes registry. The registry requires a baseline Patient Activation Measure (PAM) score at enrollment and a follow-up PAM between 4 and 12 months to assess changes in self-management activation. During a scheduled chronic care visit, the nurse documents that the patient never had a baseline PAM score recorded in the electronic health record, and no follow-up PAM was completed within the 4–12 month window after an initial score. The clinic flags the chart for care coordination. Typical workflow involves identification of registry gaps during a panel management or quality review, outreach by a nurse or medical assistant to complete the PAM by phone or during the next office visit, and documentation of attempts and barriers in the chart. Billing for the condition where the baseline or required follow-up PAM is missing is reported with M1344 to indicate non-compliance with the measurement timeline; clinical notes should document the reason for the missing baseline or missing 4–12 month follow-up, attempts at outreach, and any patient refusals or barriers to assessment. Typical sites of service include outpatient primary care clinics, chronic care management programs, care coordination offices, and telehealth or phone outreach settings.

Coding Specifications

Modifier	Description	When to Use

HCPCS M1250: Patient Felt Heard and Understood by Provider

HCPCS-M1482-HEPATITIS-C-RNA-POSITIVE-DETECTABLE

HCPCS M1482: Positive/Detectable Hepatitis C Virus RNA Test Result

HCPCS-M1419-NOT-UP-TO-DATE-COVID-19-VACCINATION-STATUS

HCPCS Level II M1419: Not Up to Date on COVID-19 Vaccinations

HCPCS-M1481-HOSPICE-PALLIATIVE-CARE-OR-DECEASED-MEASUREMENT-PERIOD

HCPCS M1481: Hospice or Palliative Care or Deceased During Measurement Period

HCPCS-M1251-PROXY-COMPLETED-HEALTH-SURVEY

HCPCS Level II M1251: Proxy-Completed Patient Health Survey

HCPCS-M1148-PATIENT-SELF-DISCHARGED-ONGOING-CARE-NOT-POSSIBLE

HCPCS Level II M1148: Ongoing Care Not Possible Due to Patient Self-Discharge

HCPCS-M1478-PSYCHOACTIVE-SUBSTANCE-ABUSE-TREATMENT

HCPCS Level II M1478: Psychoactive Substance Abuse Services

HCPCS-M1402-INITIAL-CHEMOTHERAPY-REGIMEN-MANAGEMENT

HCPCS M1402: Initial Chemotherapy Regimen Management

HCPCS-M1492-PATIENT-NO-FALL-REPORTED

HCPCS Level II M1492: Patient Did Not Report a Fall

HCPCS-M1340-WHODAS-SDS-INDEX-ASSESSMENT

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

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Taxonomy Code	Specialty	Notes
`170100000X`	Family Medicine	Primary care clinicians who manage chronic disease registries and complete PAM assessments.
`207Q00000X`	Internal Medicine	Internists overseeing chronic care management and quality metrics including PAM.
`367A00000X`	Nurse Practitioner	Nurse practitioners frequently perform assessments and outreach to collect PAM scores.
`363L00000X`	Licensed Practical/Vocational Nurse	LPNs/LVNs often administer or assist with PAM questionnaires under supervision.
`261QM0800X`	Registered Nurse	RNs coordinate care, perform phone outreach, and document barriers to PAM completion.

ICD-10 Code	Description	Clinical Relevance
Data not available in the input.	Data not available in the input.	Data not available in the input.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99490`	Chronic care management services, at least 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month	Performed in programs where PAM monitoring informs care plans and is part of monthly chronic care management workflows.
`99487`	Complex chronic care management services, first 60 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month	Used when PAM gaps are part of complex care coordination requiring extensive care planning and time.
`99458`	Each additional 20 minutes of remote CCM services provided in a calendar month	Used when follow-up outreach to obtain PAM requires additional remote CCM time.
`99401`	Preventive medicine counseling and/or risk factor reduction intervention(s)	Used when counseling occurs related to self-management activation uncovered by PAM assessment (short visits).
`G0438`	Annual wellness visit, initial	AWV visits commonly include health behavior assessments and may document baseline PAM if integrated into preventive care.
`G0439`	Annual wellness visit, subsequent	Subsequent AWVs may include follow-up PAM administration within recommended windows and documentation of changes.

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