M1406 HCPCS: Reimbursement & Benchmarks | OpenPayer

Summary & Overview

HCPCS Level II M1406: Patients Who Leave Practice During Follow-Up

HCPCS Level II code M1406 denotes patients who leave the practice during the follow-up period. Nationally, this code identifies instances of care discontinuation that affect continuity, quality measurement, and administrative tracking. Capturing these events can influence practice-level monitoring, patient outreach metrics, and reporting of follow-up-dependent services.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The coverage and claim-handling practices for M1406 vary by payer and contractual terms; inclusion in payer discussions reflects common commercial and public plan stakeholders.

Readers will learn the clinical and administrative context for M1406, typical sites where the code is applied, and what to expect when this code appears on claim lines. The publication outlines benchmarks and reporting considerations, highlights potential policy implications for follow-up-dependent services, and summarizes where data is available or missing. Data not available in the input is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareM1406HCPCS Level IIfollow-up attritionoutpatientcare discontinuationpractice managementclaims codingquality measurement

Billing Code Overview

HCPCS Level II code M1406 describes patients who leave the practice during the follow-up period. This code is used to document situations in which an enrolled patient discontinues care or otherwise departs from a practice before the scheduled follow-up visit or monitoring period is complete.

Service type: Care discontinuation / follow-up attrition tracking
Typical site of service: Outpatient clinic or ambulatory practice where ongoing follow-up or post-procedure monitoring is expected

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A patient undergoing a short-term treatment plan or surgical follow-up discontinues care before the planned follow-up period is complete. For example, a 45-year-old patient treated by an orthopedic surgeon for a distal radius fracture is seen for initial post-operative visits and scheduled for serial follow-up assessments over 12 weeks. After the second visit at two weeks, the patient relocates and does not return to the practice for remaining follow-up care. The clinical workflow documents the initial encounter, post-operative instructions, wound checks or imaging obtained, and attempts to reach the patient. The clinical record notes the date of last visit, reasons for discharge from the practice (patient-initiated transfer, relocation, or no-show despite outreach), and any pending issues requiring continuity of care, such as rehabilitation needs or imaging results to be shared with the new provider. Billing staff apply the HCPCS Level II code M1406 to indicate the patient left the practice during the follow-up period, with appropriate modifiers to reflect unusual circumstances and communication of records to another provider as appropriate.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when services required substantially greater work than typical during the interval; e.g., complex outreach and extensive documentation after patient leaves practice.

HCPCS M1411: First-Line Immune Checkpoint Inhibitor Without Chemotherapy

HCPCS-M1246-PATIENT-REPORTED-PROVIDER-UNDERSTANDING

HCPCS M1246: Patient-Reported Provider Understanding of What Matters

HCPCS-M1343-PAM-LEVEL-4-OR-INVALID-RESPONSE-ASSESSMENT

HCPCS M1343: Assessment for PAM Level 4 or Invalid PAM Responses

HCPCS-M1357-FOLLOW-UP-REDUCTION-IN-SUICIDAL-IDEATION-OR-BEHAVIOR

HCPCS Level II M1357: Reduction in Suicidal Ideation or Behavior

HCPCS-M1414-PD-L1-TEST-NOT-PERFORMED-MEDICAL-REASON

HCPCS M1414: Documentation of Medical Reason for Not Performing PD-L1 Test

HCPCS-M1416-HOSPICE-SERVICES-DURING-PERFORMANCE-PERIOD

HCPCS Level II M1416: Patient Received Hospice Services During Performance Period

HCPCS-M1361-SUICIDE-RISK-CLINICIAN-EVALUATION

HCPCS M1361: Clinician-Rated Suicide Risk Assessment

HCPCS-M1309-PALLIATIVE-CARE-SERVICES-MEASUREMENT-PERIOD

HCPCS M1309: Palliative Care Services During Measurement Period

HCPCS-M1154-HOSPICE-SERVICES-MEASUREMENT-PERIOD

HCPCS M1154: Hospice Services During Measurement Period

HCPCS-M1295-TOTAL-COLECTOMY-COLORECTAL-CANCER-HISTORY

HCPCS Level II M1295: Total Colectomy or Colorectal Cancer History

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Taxonomy Code	Specialty	Notes
`207X00000X`	Orthopedic Surgery	Common specialty managing fractures and post-operative follow-up where `M1406` may apply.
`207L00000X`	Hand Surgery	Subspecialty frequently providing serial follow-up for hand and wrist injuries.
`208000000X`	General Surgery	Performs procedures with defined follow-up periods and may document patients leaving care.
`208200000X`	Plastic Surgery	Provides surgical follow-up for reconstructive cases where patients sometimes transfer care.
`2080000005`	Surgical Oncology	Manages post-operative surveillance where patient-initiated departure can occur.

ICD-10 Code	Description	Clinical Relevance
Data not available in the input.	Data not available in the input.	Data not available in the input.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99024`	Postoperative follow-up visit, typically included in global service; used for reporting visits related to routine post-op care.	Often part of the expected follow-up that may be truncated when `M1406` is reported because the patient left the practice.
`99051`	Service during regularly scheduled evening, weekend or holiday office hours, in addition to basic service.	May be billed for extraordinary communication or outreach attempts after the patient leaves practice, depending on payer rules.
`99499`	Unlisted evaluation and management service.	Rarely used when an atypical follow-up administrative encounter is required after patient departure and no specific CPT aligns.
`G2212`	Visit complexity inherent to evaluation and management associated with additional work.	May be relevant when substantial additional documentation or care coordination occurred because the patient left care.
`99070`	Supplies and materials provided by the physician over and above those usually included with the service.	Relevant if the practice provided extra materials (e.g., durable medical equipment wiring of records or supplies) before the patient left the practice.

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