Summary & Overview
HCPCS M1347: PAM Score Improvement Over 4–12 Months
HCPCS Level II code M1347 denotes a patient who achieved a net increase of at least 3 points on the Patient Activation Measure (PAM) over a 4–12 month interval. The code documents a meaningful improvement in patient engagement and self-management capabilities and is relevant to value-based care programs, chronic disease management, and outcomes-based reporting. Nationally, capturing patient-reported outcome improvements is increasingly important for payers and providers aligning payment with quality and population health goals.
Key payers referenced include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of what the code represents, the clinical and programmatic contexts where it is used, and how it fits into outcome measurement frameworks. The publication includes benchmark considerations, typical sites of service, and payer coverage patterns where available. Policy and operational topics covered address documentation expectations, reporting intervals tied to the 4–12 month window, and implications for care management and quality programs. Data not available in the input is explicitly noted where applicable.
Billing Code Overview
HCPCS Level II code M1347 documents patients who achieved a net increase in Patient Activation Measure (PAM) score of at least 3 points within a 4 to 12 month period, indicating a passing outcome. This code captures a measurable improvement in patient self-management and activation over a defined follow-up interval.
Service Type: Patient-reported outcome assessment / population health outcome measurement
Typical Site of Service: Outpatient clinics, care management programs, home health or community-based settings where longitudinal patient activation is tracked
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult enrolled in a chronic disease management program (for example, diabetes, heart failure, chronic obstructive pulmonary disease, or major depressive disorder) who participates in a structured self-management and activation intervention. The patient completes the Patient Activation Measure (PAM) at baseline and again at a 4–12 month follow-up. The billing code M1347 applies when the patient achieves a net increase in PAM score of at least 3 points over that interval (passing). The clinical workflow includes baseline assessment and documentation of PAM score, delivery of education or behavioral coaching sessions (telehealth or in-person), periodic progress documentation, and follow-up PAM administration at 4–12 months with documented score comparison showing a ≥3 point improvement. Typical sites of service are outpatient behavioral health clinics, primary care offices, chronic care management programs, home health visits, and telehealth platforms. The typical patient scenario: a 58-year-old patient with type 2 diabetes and suboptimal self-management attends an initial coaching series and receives ongoing follow-up. Baseline PAM was 52; at 6 months the PAM is 56, reflecting a net increase ≥3 points; clinician documents interventions, timeframe, and score change and bills M1347 as applicable.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 |