2025 CPT code 98962
(Active) Effective Date: N/A Revision Date: N/A Education - Education and Training for Patient Self-Management Medicine Services and Procedures Feed
Education and training for patient self-management by a qualified nonphysician healthcare professional using a standardized curriculum; face-to-face with 5-8 patients (30 minutes).
Modifiers may be applicable depending on the circumstances of service.Consult the official CPT guidelines and payer-specific guidelines for appropriate modifier use.
The patient must have an established diagnosis requiring self-management education. The education must be medically necessary and relevant to managing the patient's condition. The payer's specific medical necessity criteria should be considered.
The qualified nonphysician healthcare professional is responsible for delivering the standardized curriculum, adapting it as needed, and ensuring patient engagement and understanding. They may collaborate with the physician to develop the curriculum or to monitor progress.
- Medicine Services and Procedures
- Medicine Services and Procedures > Education and Training for Patient Self-Management
In simple words: A nurse, therapist, or other qualified healthcare professional teaches a group of 5 to 8 patients (and possibly their caregivers) how to manage their illness or disease for 30 minutes.The class uses a standard lesson plan to help patients take control of their health.
This CPT code reports educational and training services provided by a qualified nonphysician healthcare professional to a group of 5-8 patients.The training utilizes a standardized curriculum focused on self-managing an established illness or disease, or delaying comorbidities.The curriculum may be modified to suit individual patient needs, cultural norms, and health literacy.Each 30-minute face-to-face session with the group is reported using this code. The patient (and caregiver, if applicable) must be actively involved in the session.
Example 1: A group of six diabetic patients attends a 30-minute session led by a certified diabetes educator covering insulin administration techniques, blood glucose monitoring, and healthy eating., A respiratory therapist conducts a 30-minute session with seven patients with asthma, covering inhaler use, recognizing and managing asthma attacks, and environmental triggers., A physical therapist leads a group of five patients recovering from knee replacements. The 30-minute session focuses on proper exercises, home safety, and mobility aids.
* Patient demographics and diagnosis.* Documentation that a standardized curriculum was used.* Confirmation that the educator is a qualified nonphysician healthcare professional.* Number of patients in attendance.* Date and time of the session.* Summary of topics covered.* Evidence of patient engagement.* Note indicating whether a caregiver was present and involved.
** The 30-minute time requirement refers to the face-to-face time spent with the patients. Preparation time or documentation is not included in this timeframe.The curriculum must be standardized but can be modified to meet individual patient needs.
- Revenue Code: T2D (Other Tests - Other)
- RVU: Information not available in provided sources.Consult the AMA CPT codebook or other relevant resources for RVU information.
- Global Days: Not applicable.
- Payment Status: Active
- Modifier TC rule: Not applicable.
- Fee Schedule: Information not available in provided sources. Consult fee schedules from relevant payers.
- Specialties:Many specialties could potentially use this code, including but not limited to:Cardiology, Endocrinology, Oncology, Pulmonology, Orthopedics, and Physical Therapy.
- Place of Service:Office, Outpatient Hospital, Ambulatory Surgical Center, and other relevant settings.