How To Use HCPCS Code G0109

HCPCS code G0109 describes diabetes outpatient self-management training services provided in a group session, consisting of two or more individuals, with each session lasting for 30 minutes. This code is used to identify and bill for the specific service of diabetes self-management training in a group setting.

1. What is HCPCS G0109?

HCPCS code G0109 is a specific code used in medical coding to identify and bill for diabetes outpatient self-management training services provided in a group session. It is important to note that this code is specifically used for group sessions and not for individual sessions.

2. Official Description

The official description of HCPCS code G0109 is “Diabetes outpatient self-management training services, group session (2 or more), per 30 minutes.” The short description for this code is “Diab manage trn ind/group.”

3. Procedure

1. The healthcare provider organizes a group session for diabetes outpatient self-management training.
2. The session must include a minimum of two individuals.
3. The duration of each session should be 30 minutes.
4. During the session, the healthcare provider delivers education and training on various aspects of diabetes self-management.
5. This may include topics such as blood glucose monitoring, medication management, diet and nutrition, exercise, and lifestyle modifications.
6. The provider may use various teaching methods, such as presentations, discussions, and interactive activities, to engage the participants.
7. Each participant in the group session receives personalized guidance and support based on their specific needs and goals.
8. The healthcare provider documents the details of the session, including the topics covered, participant attendance, and any individualized recommendations or interventions provided.

4. When to use HCPCS code G0109

HCPCS code G0109 should be used when billing for diabetes outpatient self-management training services provided in a group session. It is important to ensure that the session meets the criteria of having a minimum of two participants and a duration of 30 minutes. This code should not be used for individual sessions or for any other type of training or education services unrelated to diabetes self-management.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G0109, healthcare providers need to ensure that the following documentation requirements are met:

• A detailed description of the diabetes self-management training provided during the group session.
• The number of participants in the session.
• The duration of the session (30 minutes).
• Individualized recommendations or interventions provided to each participant, if applicable.

Providers should also follow the specific billing guidelines set forth by the payer, ensuring that all necessary information is included on the claim form.

6. Historical Information and Code Maintenance

HCPCS code G0109 was added to the Healthcare Common Procedure Coding System on July 01, 1998. It has an effective date of January 01, 2001. As indicated by the action code N, there have been no maintenance actions taken for this code since its addition.

7. Medicare and Insurance Coverage

HCPCS code G0109 is payable by Medicare and other insurance providers. The pricing indicator code 11 indicates that the price for this service is established using national relative value units (RVUs). The multiple pricing indicator code A signifies that this code is not applicable as HCPCS priced under one methodology.

8. Examples

Here are five examples of when HCPCS code G0109 should be billed:

1. A healthcare provider conducts a 30-minute group session on diabetes self-management training for three individuals.
2. A diabetes education center organizes a series of group sessions, each lasting for 30 minutes, to provide comprehensive diabetes self-management training to a group of patients.
3. A hospital offers a weekly support group for individuals with diabetes, where participants receive education and training on various aspects of self-management.
4. A community health center conducts a group session on diabetes self-management for a group of individuals from the local community.
5. A physician’s office organizes a group session for diabetic patients to learn about proper nutrition and meal planning for diabetes management.