Summary & Overview
HCPCS M1382: Office Patient Encounter During Performance Period
HCPCS Level II code M1382 denotes a patient encounter occurring during a specified performance period with place of service code 11, which corresponds to an office visit. Nationally, this code matters for performance measurement and reporting in outpatient office-based settings where tracking encounters during defined measurement windows is required. The code is relevant across major commercial payers and the Medicare program.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of what M1382 represents clinically and administratively, how it is used in office-based performance-period reporting, and which payers commonly accept and apply the code. The publication outlines typical site-of-service context and clarifies which components of the encounter the code is intended to capture.
The report provides practical benchmarks and policy context where available, flags gaps in publicly available mappings, and summarizes implications for billing workflows and documentation. Data not available in the input will be identified and omitted; the focus remains national in scope and centered on the code's clinical and reporting role in office-based care.
Billing Code Overview
HCPCS Level II code M1382 describes a patient encounter during the performance period with place of service code 11. This indicates a face-to-face encounter at an office for purposes tied to a defined performance period. The service type is an office-based patient encounter, and the typical site of service is office (place of service 11).
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient encounter for billing code M1382 occurs when a patient is seen in a physician office or outpatient clinic (Place of Service code 11) during the defined performance period for a durable medical equipment or orthotic/prosthetic service. A realistic scenario: a 68-year-old patient with progressive knee osteoarthritis presents to an orthopedic clinic for assessment and fitting of a custom knee brace. The patient is evaluated by an orthopedist or certified orthotist during a scheduled office visit. The clinical workflow includes verification of medical necessity, review of prior imaging and conservative treatments, measurement for the device, counseling on expected function and wear schedule, documentation of the encounter including objective findings and plan, and completion of required paperwork for device ordering and billing. The encounter documents the face-to-face service within the performance period at Place of Service 11, supports coding with M1382, and may be linked to subsequent device delivery or follow-up fittings in the same outpatient setting.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 |