Summary & Overview
HCPCS M1449: Active Diagnosis of Schizophrenia or Psychotic Disorder
HCPCS Level II code M1449 denotes an active diagnosis of schizophrenia or another psychotic disorder recorded at any time before the end of a measure assessment period. As a condition-reporting code used in behavioral health quality measurement, M1449 helps identify populations for care coordination, quality metrics, and outcome tracking. Nationally, standardized condition capture supports consistent reporting across payers and care settings and underpins performance measurement for behavioral health services.
Key payers included in the analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication outlines how M1449 is applied across typical behavioral health sites of service and what audiences can expect to find: benchmark definitions and use cases for quality measurement, clarifications about clinical context, and any recent policy guidance relevant to condition reporting. Where specific payer data or related code mappings are not available in the input, the text notes that data is not provided.
Readers will gain a concise reference to the clinical meaning of M1449, the service contexts where it is recorded, and an overview of the reporting and measurement implications for national payers and programs.
Billing Code Overview
HCPCS Level II code M1449 indicates that a patient has an active diagnosis of schizophrenia or a psychotic disorder at any time prior to the end of the measure assessment period. This code is used to capture the presence of these serious mental health conditions for measurement and reporting purposes.
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Service type: Diagnostic/clinical condition reporting for behavioral health quality measurement
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Typical site of service: Behavioral health clinics, outpatient mental health practices, community mental health centers, and inpatient psychiatric settings
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 34-year-old patient with a documented history of schizophrenia is seen in an outpatient community mental health clinic for an annual quality-measure assessment. The patient’s chart shows past and current antipsychotic treatment, periodic psychiatric follow-up visits, and social work care coordination. During the assessment period the clinician confirms the active diagnosis of schizophrenia in the problem list and documents psychotic symptoms, treatment plan, and medication reconciliation in the electronic health record. The clinical workflow for this measure includes: initial chart review by a quality specialist or clinician; verification of diagnosis in the problem list and encounter notes; cross-check of medication and hospitalization history; coders or billing staff assigning the appropriate population-health billing code; and submission of the completed measure to the payer or quality registry. Typical staff involved are psychiatrists, psychiatric nurse practitioners, licensed clinical social workers, care coordinators, and medical coders. Typical sites of service are outpatient psychiatric clinics, community mental health centers, integrated behavioral health clinics, and inpatient psychiatry for documentation of active diagnosis during the measurement period.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service | Use when a psychiatric E/M visit is performed in addition to another distinct procedure or service on the same day and documentation supports a separate E/M |