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The CPT® Code 98961 refers to a specific type of educational service provided by a nonphysician qualified health care professional. This service focuses on patient self-management, which is essential for individuals dealing with chronic diseases, injuries, or other health-related issues. The education and training are delivered face-to-face, allowing for direct interaction between the health care professional and the patients, which can enhance understanding and retention of the information provided. The sessions may also include family members or caregivers, recognizing the important role they play in supporting the patient’s health management. The content of the education is based on a standardized curriculum, ensuring that the information is consistent and reliable, although it can be tailored slightly to meet the specific needs of the patients present. This code is applicable when the session involves 2 to 4 patients simultaneously, allowing for a group learning environment that can foster discussion and shared experiences among participants. Each session is billed in 30-minute increments, reflecting the time spent in direct education and training activities.
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The CPT® Code 98961 is indicated for use in situations where a nonphysician qualified health care professional provides education and training aimed at enhancing patient self-management. This service is particularly relevant for patients who are managing chronic diseases, injuries, or other health problems that require ongoing education and support. The presence of family members or caregivers during these sessions is encouraged, as they can play a crucial role in the patient's health management. The structured educational approach is designed to empower patients and their support systems with the knowledge and skills necessary to effectively manage their health conditions.
The procedure associated with CPT® Code 98961 involves several key steps that ensure effective education and training for the patients. Each session is structured to last for 30 minutes, during which the nonphysician qualified health care professional engages with the patients in a face-to-face setting. This direct interaction is crucial for fostering a supportive learning environment. The first step involves the professional assessing the specific needs of the group of patients, which may include understanding their individual health conditions and any particular challenges they face in managing their health. Following this assessment, the professional delivers the standardized curriculum, which covers essential topics related to self-management, such as medication adherence, lifestyle modifications, and monitoring of symptoms. Throughout the session, the professional encourages questions and discussions among the patients, allowing them to share experiences and learn from one another. The session may also include demonstrations of self-management techniques or the use of tools that can aid in their health management. Finally, the professional concludes the session by summarizing key points and providing additional resources or materials that patients can refer to after the meeting.
After the completion of the education and training session coded under CPT® Code 98961, patients are expected to apply the knowledge and skills they have acquired to their daily health management routines. The nonphysician qualified health care professional may provide follow-up resources, such as pamphlets or access to online materials, to reinforce the information shared during the session. It is also advisable for patients to schedule follow-up appointments or additional group sessions to continue their education and address any new questions or challenges that may arise. The involvement of family members or caregivers is encouraged to ensure that they can support the patient effectively in implementing the self-management strategies discussed. Overall, the goal of the post-procedure phase is to empower patients to take an active role in their health care, leading to improved health outcomes and enhanced quality of life.
| Short Descr | EDU&TRN PT SLF-MGMT NQHP 2-4 | Medium Descr | EDUCATION&TRAINING PT SELF-MGMT NQHP 2-4 PTS | Long Descr | Education and training for patient self-management by a nonphysician qualified health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/family) each 30 minutes; 2-4 patients | Status Code | Bundled Code | Global Days | XXX - Global Concept Does Not Apply | PC/TC Indicator (26, TC) | 9 - Not Applicable | Multiple Procedures (51) | 9 - Concept does not apply. | Bilateral Surgery (50) | 9 - Concept does not apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 9 - Concept does not apply. | Co-Surgeons (62) | 9 - Concept does not apply. | Team Surgery (66) | 9 - Concept does not apply. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Items and Services Packaged into APC Rates | Type of Service (TOS) | 1 - Medical Care | Berenson-Eggers TOS (BETOS) | T2D - Other tests - other | MUE | 0 | CCS Clinical Classification | 237 - Ancillary Services |
| GY | Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit | 95 | Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system: synchronous telemedicine service is defined as a real-time interaction between a physician or other qualified health care professional and a patient who is located at a distant site from the physician or other qualified health care professional. the totality of the communication of information exchanged between the physician or other qualified health care professional and the patient during the course of the synchronous telemedicine service must be of an amount and nature that would be sufficient to meet the key components and/or requirements of the same service when rendered via a face-to-face interaction. modifier 95 may only be appended to the services listed in appendix p. appendix p is the list of cpt codes for services that are typically performed face-to-face, but may be rendered via a real-time (synchronous) interactive audio and video telecommunications system. | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | A2 | Dressing for two wounds | AT | Acute treatment (this modifier should be used when reporting service 98940, 98941, 98942) | GT | Via interactive audio and video telecommunication systems | SA | Nurse practitioner rendering service in collaboration with a physician | U2 | Medicaid level of care 2, as defined by each state |
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| 2025-01-01 | Changed | Short, Medium, and Long Descriptions changed. |
| 2011-01-01 | Changed | Medium description changed. Short description changed. |
| 2006-01-01 | Added | First appearance in code book in 2006. |
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