How To Use CPT Code 98960

CPT 98960 refers to the education and training for patient self-management by a qualified, nonphysician healthcare professional using a standardized curriculum, face-to-face with the patient for 30 minutes. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 98960.

1. What is CPT 98960?

CPT 98960 is a medical billing code used to describe the education and training services provided by a qualified, nonphysician healthcare professional to a patient for self-management of their disease or disorder. This code is used when the healthcare professional spends 30 minutes face-to-face with an individual patient, using a standardized curriculum to educate and train the patient on how to effectively manage their condition.

2. 98960 CPT code description

The official description of CPT code 98960 is: “Education and training for patient self-management by a qualified, nonphysician health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/family) each 30 minutes; individual patient.”

3. Procedure

  1. The healthcare professional assesses the patient’s condition and determines the need for self-management education and training.
  2. A standardized curriculum is selected or modified to suit the patient’s specific health condition and circumstances.
  3. The healthcare professional schedules a 30-minute face-to-face session with the patient (and possibly their caregiver or family).
  4. During the session, the healthcare professional educates the patient on their condition and provides training on how to manage it effectively.
  5. The healthcare professional may also discuss lifestyle changes, medication management, and other relevant topics to help the patient improve their self-management skills.
  6. Additional sessions may be scheduled as needed to ensure the patient fully understands and can effectively manage their condition.

4. Qualifying circumstances

Patients eligible to receive CPT 98960 services are those with an established illness or disease that requires self-management education and training. Examples of such conditions include asthma, diabetes, hypertension, and chronic pain. The patient must be under the care of a qualified, nonphysician healthcare professional, such as a nurse, physician assistant, nurse practitioner, physical therapist, respiratory therapist, or trained social worker. The healthcare professional must use a standardized curriculum to provide the education and training, and the session must be face-to-face with the patient for 30 minutes.

5. When to use CPT code 98960

It is appropriate to bill the 98960 CPT code when a qualified, nonphysician healthcare professional provides a 30-minute face-to-face education and training session for an individual patient using a standardized curriculum. This code should be used for each 30-minute session provided to the patient. If the session involves a group of two to four patients, use CPT code 98961. For a group of five to eight patients, use CPT code 98962.

6. Documentation requirements

To support a claim for CPT 98960, the healthcare professional must document the following information:

  • Patient’s diagnosis and the need for self-management education and training
  • Specific standardized curriculum used or modified for the patient’s condition
  • Date, start and end time of the 30-minute face-to-face session
  • Topics covered during the session, such as lifestyle changes, medication management, and self-monitoring techniques
  • Progress made by the patient and any additional sessions scheduled
  • Signature of the qualified, nonphysician healthcare professional providing the service

7. Billing guidelines

When billing for CPT 98960, ensure that the healthcare professional providing the service is a qualified, nonphysician professional, and that the session is face-to-face with the patient for 30 minutes. Use the appropriate CPT code based on the number of patients in the session (98961 for two to four patients, 98962 for five to eight patients). Be sure to document all required information to support the claim, as outlined in the documentation requirements section.

8. Historical information

CPT 98960 was added to the Current Procedural Terminology system on January 1, 2006. There have been no updates to the code since its addition.

9. Similar codes to CPT 98960

Five similar codes to CPT 98960 include:

  • CPT 98961: This code is used for the same service as CPT 98960 but involves a group of two to four patients.
  • CPT 98962: This code is used for the same service as CPT 98960 but involves a group of five to eight patients.
  • CPT 98966: This code is used for telephone assessment and management services provided by a qualified, nonphysician healthcare professional to an established patient or their caregiver.
  • CPT 98967: This code is used for telephone assessment and management services provided by a qualified, nonphysician healthcare professional to an established patient or their caregiver, lasting between 21 and 30 minutes.
  • CPT 98968: This code is used for telephone assessment and management services provided by a qualified, nonphysician healthcare professional to an established patient or their caregiver, lasting 31 minutes or more.

10. Examples

  1. A nurse providing a 30-minute face-to-face education and training session on diabetes self-management for an individual patient.
  2. A respiratory therapist teaching an asthma patient how to use their inhaler and monitor their symptoms during a 30-minute face-to-face session.
  3. A physical therapist providing a 30-minute face-to-face session on pain management techniques for a patient with chronic pain.
  4. A nurse practitioner educating a patient with hypertension on lifestyle changes and medication management during a 30-minute face-to-face session.
  5. A trained social worker providing a 30-minute face-to-face session on stress management techniques for a patient with anxiety.
  6. A physician assistant teaching a patient with COPD how to use a spirometer and manage their symptoms during a 30-minute face-to-face session.
  7. A nurse providing a 30-minute face-to-face education and training session on self-monitoring techniques for a patient with heart failure.
  8. A physical therapist teaching a patient with arthritis how to perform exercises to manage their pain during a 30-minute face-to-face session.
  9. A respiratory therapist providing a 30-minute face-to-face session on proper use of a CPAP machine for a patient with sleep apnea.
  10. A nurse practitioner educating a patient with irritable bowel syndrome on dietary changes and symptom management during a 30-minute face-to-face session.

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