2025 CPT code 98961
(Active) Effective Date: N/A Revision Date: N/A Education and Training - 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; 30 minutes, 2-4 patients.
Modifiers may be applicable in certain circumstances, such as modifier 59 (distinct procedural service) if the education session is distinct from other services provided on the same date.Consult the most up-to-date CPT guidelines for modifier usage.
Medical necessity is established when the patient has an established illness or disease (e.g., diabetes, asthma, heart failure) and the education and training is deemed necessary to improve self-management skills and reduce the risk of complications or hospitalizations.This should be supported by relevant clinical documentation, such as the patient's diagnosis and treatment plan.
The qualified nonphysician healthcare professional is responsible for delivering the standardized curriculum, adapting it as needed, and ensuring the patient's active engagement in the self-management training.This may involve coaching techniques to empower the patient and increase self-efficacy.
- Medicine Services and Procedures
- Medicine Services and Procedures > Education and Training for Patient Self-Management
In simple words: A healthcare professional (like a nurse or therapist, not a doctor) teaches patients (and their families if needed) how to manage their illness for 30 minutes.This is done in a group of 2 to 4 people using a set teaching plan. The goal is to help patients better manage their health.
This CPT code reports educational and training services provided by a qualified nonphysician healthcare professional to a group of 2-4 patients. The services utilize a standardized curriculum focused on patient self-management of an established illness or disease, or to delay comorbidity.The curriculum may be modified to suit individual patient needs, cultural norms, and health literacy.The session lasts 30 minutes and includes face-to-face interaction with the patient(s) and potentially caregivers or family members.The healthcare professional's qualifications and curriculum must align with established guidelines from relevant professional societies.
Example 1: A diabetes educator (RN) conducts a 30-minute group session for three patients with type 2 diabetes, covering medication management, blood glucose monitoring, and dietary adjustments.Caregivers are also included in the session., A respiratory therapist (RT) teaches four patients with asthma about inhaler techniques, recognizing and managing asthma triggers, and creating personalized action plans.The session includes interactive exercises and question-and-answer time., A physical therapist (PT) leads a group session for two patients recovering from knee replacements.The session focuses on proper exercise techniques, home safety modifications, and pain management strategies. The patients' spouses also participate.
Detailed session notes should include the date, time, attendees (patients, caregivers), topics covered, patient participation, and any modifications made to the curriculum based on individual needs.Documentation should also verify the healthcare professional's qualifications and that a standardized curriculum was used.
** This code is limited to 4 units in a 24-hour period and no more than 24 units per calendar month per patient, as per some payer policies.Always verify payer-specific rules and billing guidelines before submitting claims.
- Payment Status: Active
- Specialties:Diabetes education, respiratory therapy, physical therapy, cardiac rehabilitation, oncology, chronic disease management
- Place of Service:Office, clinic, hospital, telehealth (depending on payer policies)