Summary & Overview
HCPCS M1367: Quality Care for ENT Disorders MIPS Value Pathway
HCPCS Level II code M1367 denotes a quality-care measure tied to the treatment of ear, nose, and throat (ENT) disorders within a MIPS Value Pathway framework. As a code focused on quality and pathway-linked services, it matters nationally because performance reporting and alignment with value-based programs affect provider payment adjustments, public reporting, and care coordination across outpatient ENT settings. Major payers in scope for this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
Readers will find a concise overview of the code’s clinical intent and service contexts, an explanation of typical sites of service where the pathway-based ENT quality activities occur, and the payer landscape covered in the national analysis. The publication also summarizes benchmarks and policy considerations relevant to performance-measure reporting, potential interactions with value-based purchasing and MIPS participation, and the clinical context for ENT-specific quality measures. Data not available in the input will be noted where applicable.
Billing Code Overview
HCPCS Level II code M1367 represents quality care for the treatment of ear, nose, and throat disorders MIPS value pathway. The code maps to services focused on clinical quality and performance measurement within otolaryngology-related care, framed for the Merit-based Incentive Payment System (MIPS) Value Pathway associated with ear, nose, and throat (ENT) disorders.
Service Type: Quality measurement and care coordination for ENT disorders
Typical Site of Service: Outpatient specialty clinics, ambulatory surgical centers, and other outpatient settings where ENT quality reporting and pathway-based care are delivered
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 45-year-old patient presents to an otolaryngology clinic with chronic sinonasal congestion, recurrent sinusitis, and persistent nasal obstruction despite medical therapy. After history, nasal endoscopy, and symptom scoring, the clinician recommends participation in a quality care pathway for ear, nose, and throat disorders linked to MIPS reporting — focusing on comprehensive evaluation, shared decision-making, symptom tracking, and evidence-based interventions. The clinical workflow includes: initial evaluation by an otolaryngologist or advanced practice provider; diagnostic nasal endoscopy and documentation of findings; ordering or review of imaging (CT sinus) when indicated; medical management optimization (intranasal steroids, saline irrigation, antibiotics when bacterial infection suspected); consideration of procedural interventions (endoscopic sinus surgery or office-based nasal procedures) if medical therapy fails; pre- and post-procedure counseling and MIPS-quality measure documentation; and scheduled follow-up visits to capture outcomes, patient-reported symptom scores, and care coordination notes for quality reporting. Typical site of service is an outpatient otolaryngology clinic, with possible transitions to ambulatory surgery center or hospital outpatient department if operative intervention is required. Typical patient scenario: adult with refractory chronic rhinosinusitis enrolled in a MIPS value pathway for ENT disorders to track adherence to guideline-based care, shared decision-making, and outcome measures.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 |