M1343 — Patients who are at pam level 4 at baseline or patients who are flagged with extreme straight line response sets on the pam or with excessive missing responses
M1343 is a HCPCS Level II code for patients who are at pam level 4 at baseline or patients who are flagged with extreme straight line response sets on the pam or with excessive missing responses. It belongs to the Medical Services section. Whether Medicare pays it depends on the coverage rule below.
Medicare coverage: Carrier judgment
Coverage is decided by your Medicare contractor, not by national policy. Whether this is paid depends on the LCD for your jurisdiction and on what the documentation supports.
From the coverage field of the CMS Alpha-Numeric HCPCS File, release 2026Q3-Jul. This states Medicare’s position on the code, not on your particular claim.
Physician fee schedule statusM
Measurement code. Used for reporting purposes only; never paid.
Global period: XXX
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The CMS record for M1343
- Long descriptor
- Patients who are at pam level 4 at baseline or patients who are flagged with extreme straight line response sets on the pam or with excessive missing responses
- Short descriptor
- Pt pam lvl 4 base or srt lin
- Added
- January 1, 2024
- BETOS
- Z2
- Pricing indicator
- 00 — Not priced by Part B
The official wording. This is what the code means.
CMS's 28-character form, which is what shows up on a remittance advice.
When CMS introduced the code.
Berenson-Eggers Type of Service — CMS's own analytic grouping.
Service not separately priced by Part B — not covered, bundled into another service, or used by Part A only.
Codes adjacent to M1343
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If M1343 is not quite right, the correct code is very often within a few positions of it.
- M1335Documentation of patient reason(s) for not having a follow up exam (e.g., inadequate time for follow up)
- M1336Patients who were appropriately evaluated during the initial exam and were re-evaluated no later than 2 weeks
- M1337Acute pvd
- M1338Patients who had follow-up assessment 30 to 180 days after the index assessment who did not demonstrate positive improvement or maintenance of functioning scores during the performance period
- M1339Patients who had follow-up assessment 30 to 180 days after the index assessment who demonstrated positive improvement or maintenance of functioning scores during the performance period
- M1340Index assessment completed using the 12-item whodas 2.0 or sds during the denominator identification period
- M1341Patients who did not have a follow-up assessment or did not have an assessment within 30 to 180 days after the index assessment during the performance period
- M1342Patients who died during the performance period
- M1344Patients who did not have a baseline pam score and/or a second score within 4 to 12 months of baseline pam score
- M1345Patients who had a baseline pam score and a second score within 4 to 12 month of baseline pam score
- M1346Patients who did not have a net increase in pam score of at least 6 points within a 4 to 12 month period
- M1347Patients who achieved a net increase in pam score of at least 3 points in a 4 to 12 month period (passing)
- M1348Patients who achieved a net increase in pam score of at least 6-points in a 4 to 12 month period (excellent)
- M1349Patients who did not have a net increase in pam score of at least 3 points within a 4 to 12 month period
- M1350Patients who had a completed suicide safety plan initiated, reviewed or updated in collaboration with their clinician (concurrent or within 24 hours) of the index clinical encounter
- M1351Patients who had a suicide safety plan initiated, reviewed, or updated and reviewed and updated in collaboration with the patient and their clinician concurrent or within 24 hours of clinical encounter and within 120 days after initiation
Questions about M1343
What is HCPCS code M1343?
M1343 is a HCPCS Level II code for patients who are at pam level 4 at baseline or patients who are flagged with extreme straight line response sets on the pam or with excessive missing responses. It sits in the Medical Services section.
Does Medicare cover M1343?
The CMS HCPCS file marks M1343 as "Carrier judgment". Coverage is decided by your Medicare contractor, not by national policy. Whether this is paid depends on the LCD for your jurisdiction and on what the documentation supports.
How is M1343 paid under the physician fee schedule?
M1343 carries PFS status code M. Measurement code. Used for reporting purposes only; never paid.