Summary & Overview
HCPCS M1349: No Net PAM Score Improvement (4–12 Month Follow-Up)
HCPCS Level II code M1349 denotes patients who did not achieve a net increase of at least 3 points on the Patient Activation Measure (PAM) within a 4 to 12 month interval. The code flags lack of measurable improvement in patient activation, an outcome relevant to chronic disease self-management, care management programs, and value-based arrangements that track patient-reported outcomes. Nationally, tracking activation outcomes supports quality measurement, care coordination, and program evaluation across outpatient and community settings.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare and Medicare. Readers will find context on the clinical meaning of the code, typical service settings where it is applied, and the role such outcome codes play in quality monitoring and contract performance frameworks. The publication outlines common use cases for M1349, notes gaps where input data is missing, and identifies what benchmarks and policy updates are relevant to stakeholders tracking patient-reported outcome measures at scale.
This summary is intended for national audiences involved in reimbursement policy, quality measurement, care management, and health plan contracting who need a concise explanation of the code and its operational implications.
Billing Code Overview
HCPCS Level II code M1349 indicates patients who did not have a net increase in PAM score of at least 3 points within a 4 to 12 month period. This code is used to identify outcomes where patient activation, as measured by the Patient Activation Measure (PAM), did not improve by the specified threshold over the defined follow-up window.
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Service type: Outcome assessment / patient activation follow-up
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Typical site of service: Outpatient or community-based follow-up visits, care management encounters, or remote outcome monitoring where PAM scores are reassessed between 4 and 12 months after baseline
Data not available in the input for associated taxonomies, specific ICD-10 diagnoses, and related billing lines.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult enrolled in a patient activation or self-management program who completed baseline Patient Activation Measure (PAM) scoring and underwent a structured coaching or education intervention. Over a 4–12 month follow-up interval the patient did not achieve a net increase of at least 3 PAM points, indicating insufficient improvement in activation. Usual workflow: baseline PAM assessment at program entry; individualized care plan and education sessions (telephone, telehealth, or in-person); interim monitoring visits at 1–6 months; repeat PAM at 4–12 months; documentation of PAM scores, interventions delivered, barriers encountered, and plan for ongoing care. Typical sites of service include outpatient primary care clinics, chronic disease management programs, behavioral health clinics, and home- or community-based care delivered by certified health coaches or care managers. Common patient characteristics include chronic conditions requiring self-management (for example, diabetes, congestive heart failure, COPD), low baseline activation, social determinants impacting engagement, or cognitive/behavioral barriers that limited response to the intervention.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when the service required substantially greater resources or work than typical due to complexity of care coordination or extensive documentation associated with lack of PAM improvement. |