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The CPT® Code 98962 refers to a specific type of educational service provided by a nonphysician qualified health care professional. This service involves face-to-face education and training aimed at empowering patients to manage their own health conditions effectively. The training is conducted using a standardized curriculum, which ensures that the information provided is consistent and reliable. During these sessions, the primary focus is on individual patients, but the presence of family members or caregivers is also encouraged, as their involvement can enhance the learning experience and support the patient’s self-management efforts. The educational sessions are structured to accommodate groups of patients, specifically those with 5 to 8 individuals participating simultaneously. Each session is billed in 30-minute increments, allowing for flexibility in scheduling and ensuring that adequate time is allocated for comprehensive instruction. This code is particularly relevant for health care professionals who are engaged in teaching patients about managing diseases, injuries, or other health-related issues, thereby promoting better health outcomes through informed self-care practices.
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The CPT® Code 98962 is indicated for use in situations where a nonphysician qualified health care professional provides education and training for patient self-management. This service is particularly relevant for patients who require guidance on managing specific health conditions, injuries, or other health problems. The presence of family members or caregivers during these sessions is also indicated, as their involvement can facilitate better understanding and support for the patient’s self-management efforts.
The procedure associated with CPT® Code 98962 involves several key steps that ensure effective delivery of education and training. First, the nonphysician qualified health care professional prepares for the session by reviewing the standardized curriculum that will be utilized during the training. This curriculum is designed to cover essential topics related to the management of the specific health conditions affecting the patients in attendance.
After the educational session, it is expected that patients will begin to apply the self-management techniques learned during the training. The nonphysician qualified health care professional may provide additional resources or materials to support ongoing learning and application of the concepts discussed. Follow-up sessions may be recommended to reinforce the training and address any new questions or challenges that arise as patients implement their self-management strategies. It is important for the professional to encourage patients to communicate any difficulties they encounter, as this feedback can be valuable for future educational efforts.
| Short Descr | EDU&TRN PT SLF-MGMT NQHP 5-8 | Medium Descr | EDUCATION&TRAINING PT SELF-MGMT NQHP 5-8 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; 5-8 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 |
| 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. | 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 | 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. | AT | Acute treatment (this modifier should be used when reporting service 98940, 98941, 98942) | GP | Services delivered under an outpatient physical therapy plan of care | GW | Service not related to the hospice patient's terminal condition | GZ | Item or service expected to be denied as not reasonable and necessary |
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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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