Summary & Overview
HCPCS M1345: Follow-up Patient Activation Measure (4–12 Months)
HCPCS Level II code M1345 identifies patients with a baseline Patient Activation Measure (PAM) score and a repeat PAM score recorded 4 to 12 months later. This code captures longitudinal assessment of patient self-management activation, which is increasingly important for chronic disease management, value-based care programs, and quality measurement nationally. Tracking PAM scores helps providers and payers monitor engagement, tailor interventions, and document outcomes over time.
Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the code’s clinical intent, expected settings of service, common payment considerations, and how it fits into population health workflows. The publication outlines typical reporting contexts and what benchmarks or data elements are relevant for payers and providers when this measure is billed.
This summary provides the clinical context for M1345, practical implications for care delivery and measurement, and pointers to areas where policy updates or payer coverage rules may affect use. Data not provided in the input are noted as unavailable; the report focuses on national relevance rather than state-specific guidance.
Billing Code Overview
HCPCS Level II code M1345 describes patients who had a baseline Patient Activation Measure (PAM) score and a second PAM score recorded within 4 to 12 months of the baseline. The service type is follow-up patient activation measurement and monitoring. The typical site of service for this activity is outpatient settings where patient-reported outcome measures or care management follow-up occur, such as primary care clinics, behavioral health clinics, chronic care management programs, or population health programs.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with a chronic condition or recent care transition enrolled in a primary care or chronic care management program who completed a baseline Patient Activation Measure (PAM) assessment and a follow-up PAM between 4 and 12 months later to evaluate changes in self-management skills. The workflow begins when a clinician or care manager documents the baseline PAM score at an initial visit or enrollment. The patient receives targeted coaching, education, or care-plan interventions over months. Between 4 and 12 months after baseline, the care team schedules a follow-up encounter (in-person, telehealth, or structured telephone visit) to administer the second PAM assessment, document the two scores in the medical record, and update the care plan based on changes in activation. Typical sites of service include outpatient primary care clinics, behavioral health integration settings, chronic care management programs, patient-centered medical homes, and telehealth or remote monitoring programs. Common patient presentations include patients with diabetes, heart failure, chronic obstructive pulmonary disease, or multiple chronic conditions requiring self-management support and reassessment of activation level.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when the PAM reassessment required substantially greater work than typical (rare for this service). |