How To Use CPT Code 98962

CPT 98962 describes the education and training for patient self-management by a qualified, nonphysician healthcare professional using a standardized curriculum, face-to-face with a group of five to eight patients for 30 minutes. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 98962?

CPT 98962 is used to describe the education and training services provided by a qualified, nonphysician healthcare professional to a group of five to eight patients for self-management of their disease or disorder. This code is used when the healthcare professional spends 30 minutes face-to-face with the group, using a standardized curriculum to educate and train the patients on how to effectively manage their condition.

2. Official Description

The official description of CPT code 98962 is: ‘Education and training for patient self-management by a qualified, nonphysician healthcare professional using a standardized curriculum, face-to-face with the patient (could include caregiver/family) each 30 minutes; 5-8 patients.’

3. Procedure

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

4. Qualifying circumstances

Patients eligible to receive CPT 98962 services are those with established illnesses or diseases that require self-management education and training. Examples of such conditions include asthma, diabetes, hypertension, and chronic pain. The patients 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 group of patients for 30 minutes.

5. When to use CPT code 98962

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

6. Documentation requirements

To support a claim for CPT 98962, the healthcare professional must document the following information:

• Diagnoses of the patients and the need for self-management education and training
• Specific standardized curriculum used or modified for the group’s conditions
• 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 patients and any additional sessions scheduled
• Signature of the qualified, nonphysician healthcare professional providing the service

7. Billing guidelines

When billing for CPT 98962, ensure that the healthcare professional providing the service is a qualified, nonphysician professional, and that the session is face-to-face with the group of patients for 30 minutes. Do not report CPT 98962 if CPT codes 98960 or 98961 have already been performed in the previous seven days. Consider the location of the testing when coding pulmonary function tests (PFTs) as they have both a professional and technical component. Modifier 26 should be used when reporting 94375, and the facility should report 94375 with modifier TC.

8. Historical information

CPT 98962 was added to the Current Procedural Terminology system on January 1, 2006. There have been no updates to the code since its addition.

9. Examples

1. A nurse providing a 30-minute face-to-face education and training session on diabetes self-management for a group of five to eight patients.
2. A respiratory therapist teaching a group of five to eight asthma patients how to use their inhalers 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 group of five to eight patients with chronic pain.
4. A nurse practitioner educating a group of five to eight patients 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 group of five to eight patients with anxiety.
6. A physician assistant teaching a group of five to eight patients 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 group of five to eight patients with heart failure.