2025 CPT code 99078
(Active) Effective Date: N/A Revision Date: N/A Medicine - Patient Education Medicine Services and Procedures > Special Services, Procedures and Reports Feed
Group patient education services (e.g., diabetic, prenatal, obesity instruction).
Modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) is required when billed with an E&M code.Modifier 51 (Multiple procedures) should not be appended.
Medical necessity is established by the patient's diagnosis and the need for the education to improve self-management of their condition.The education should be relevant to the patient's condition and care plan.
The provider prepares and delivers group instruction on a specific health topic to patients.This includes developing educational materials and facilitating group discussion and activities.
- Medicine Services and Procedures > Special Services, Procedures and Reports
- Special Services, Procedures, and Reports
In simple words: The doctor or another qualified healthcare professional teaches a class to a group of patients about a health topic, such as diabetes or preparing for a baby.The class isn't based on how long it lasts, and the doctor might teach multiple patients in the same class.The doctor will also bill separately for the visit itself.
This CPT code, 99078, represents physician or other qualified healthcare professional educational services delivered to patients in a group setting.Examples include prenatal, obesity, or diabetic instruction.The service encompasses the preparation and delivery of structured educational content to a group of patients.This code is not time-based; multiple patients may be included in a single session.It's crucial to note that this code is reported in addition to an associated basic service (such as an office visit), with modifier 25 appended to indicate a significant, separately identifiable E&M service.Some payers might not reimburse for services covered by 99078; contractual obligations should be verified.
Example 1: A physician conducts a group diabetes education session for newly diagnosed patients, covering topics such as blood glucose monitoring, medication management, diet, and exercise.A separate E&M code is billed for the initial patient visit., An endocrinology nurse educator leads a group session for patients with type 2 diabetes focusing on healthy eating habits.This is billed in addition to the patient's regular office visit E/M code., An obstetrician conducts a group prenatal class for expectant mothers, covering topics such as labor and delivery, breastfeeding, and newborn care. The class is an adjunct service to prenatal care visits, with an appropriate E/M code used for those visits.
Documentation should include the topic of the education, the number of patients present, the date and duration of the session, and the specific educational materials used.A summary of the key points discussed should be documented.Medical necessity should be supported by the patient's diagnosis and need for the education.
** Verify payer-specific coverage and reimbursement policies before billing.Always ensure proper documentation to support medical necessity and the appropriateness of the education provided.
- Revenue Code: Y1 (OTHER - MEDICARE FEE SCHEDULE)
- Payment Status: Active (but payer-specific reimbursement varies)
- Modifier TC rule: Not applicable
- Specialties:Endocrinology, Obstetrics/Gynecology, Family Medicine, Internal Medicine
- Place of Service:Office, Outpatient Hospital, Community Mental Health Center, Federally Qualified Health Center,Other Place of Service (depending on the provider and the clinical setting)