2025 CPT code 98960
(Active) Effective Date: N/A Revision Date: N/A Education and Training - Education and Training for Patient Self-Management Medicine Services and Procedures Feed
Individual patient education and training for self-managing a disease, conducted by a qualified non-physician, using a standardized curriculum; 30-minute session.
Modifiers may be applicable depending on the circumstances (e.g., 25 for significant separate evaluation and management service, 59 for distinct procedural service, etc.). Consult current modifier guidelines.
Medical necessity is established when the patient has a diagnosed condition requiring self-management education and training to improve outcomes and prevent complications.The service must be medically appropriate and provided by a qualified professional using a recognized curriculum.
The qualified non-physician healthcare professional is responsible for delivering the standardized curriculum, adapting it to the patient's needs, and providing coaching to support self-management behaviors.This requires expertise in the specific condition being addressed.
- Medicine Services and Procedures
- Medicine Services and Procedures > Education and Training for Patient Self-Management
In simple words: A trained healthcare professional (not a doctor) teaches a patient how to better manage their illness using a set plan.The lesson lasts 30 minutes and may include the patient's family or caregiver.
This CPT code reports educational and training services provided by a qualified non-physician healthcare professional to an individual patient.The services must utilize a standardized curriculum designed to teach self-management of an established illness or disease, or to delay comorbidity. The curriculum may be modified to meet individual patient needs. Each reported instance represents a 30-minute face-to-face session with the patient (and potentially their caregiver/family).
Example 1: A certified diabetes educator (CDE) teaches a newly diagnosed Type 2 diabetic patient about blood glucose monitoring, medication management, healthy eating, and exercise., A respiratory therapist educates an asthma patient on proper inhaler technique, recognizing and managing asthma exacerbations, and creating an action plan., A nurse practitioner instructs a heart failure patient on medication adherence, fluid restrictions, symptom recognition, and when to seek medical attention.
Detailed documentation should include the patient's diagnosis, the standardized curriculum used (including any modifications), the specific topics covered, the patient's understanding of the material, and any goals set for self-management.The provider's qualifications should also be documented.
** The qualified non-physician healthcare professional must meet established qualifications within their profession. The standardized curriculum used should align with established guidelines or standards of a recognized professional organization.Payers may have specific requirements or limitations on reimbursement for this code.
- RVU: This information is not available in the provided sources.RVUs vary based on location and payer.
- Global Days: Not applicable. This is not a surgical procedure.
- Payment Status: Active
- Modifier TC rule: Not applicable.
- Fee Schedule: Fee schedule data is not available in the provided source.Consult local fee schedules and payer-specific rates for current reimbursement.
- Specialties:Diabetes education, respiratory therapy, cardiac rehabilitation, chronic disease management, and other relevant specialties.
- Place of Service:Office, hospital outpatient department, clinic, telehealth (if appropriate and allowed by payer).