Code Description Who can Payers PDCM Notes Documentation provide BCBSM service? BCBSM/BCBSM MA 98961, 98962: 98961: BCBSM Y All Payers Description: Formalized educational sessions Lead Care Group Education and Commercial, Description: Formalized led by qualified non-physician personnel Manager and Education and training for BCBSM educational sessions led by delivered in a group setting Other Care Team Training patient self- Medicare qualified non-physician Members management Advantage, personnel delivered in a group Documentation: for 2–4 Priority setting Name, Licensure of Group Visit Priority Health patients; each Health all Conditions of Payment: Facilitator(s) Primary Care Physician QHP 30 minutes plan with At least two, but no more than Date of the 8 patients present Number of Patients in exception of There must be some level of Attendance: 2-4 patients or 5-8 Medicaid individualized interaction patients included in the session Visit Duration: 30 min 60 min 90 min if Must use a >90 min, indicate total minutes standardized Diagnoses Relevant to the Group Visit curriculum. 98962: Location of Class Claims Reporting Requirements: Education and Nature and Content of Group Visit Family members should not be training for Objective(s) of the Training counted as patients patient self- Status Update: Medical Condition, Care All active dx should be management Progress to Goal, Interventions, and reported for 5–8 Target Dates Bill separately for each patients; each Have some level of individualized individual patient 30 minutes interaction(BCBSM) Quantity Limits: None. May be All active diagnosis quantity billed.
Code Description Who can provide service? Payers PDCM BCBSM Notes Documentation 98961, 98962: Group Education and Training 98961: Education and training for patient self- management for 2–4 patients; each 30 minutes BCBSM/BCBSM MA Lead Care Manager and Other Care Team Members Priority Health QHP BCBSM Commercial, BCBSM Medicare Advantage, Priority Health all plan with the exception of Medicaid Y All Payers Description: Formalized educational sessions led by qualified non-physician personnel delivered in a group setting Conditions of Payment: At least two, but no more than 8 patients present There must be some level of individualized interaction included in the session Must use a standardized curriculum. Claims Reporting Requirements: Family members should not be counted as patients All active dx should be reported Bill separately for each individual patient Quantity Limits: None. May be quantity billed. Description: Formalized educational sessions led by qualified non-physician personnel delivered in a group setting Documentation: Name, Licensure of Group Visit Facilitator(s) Primary Care Physician Date of Number of Patients in Attendance: 2-4 patients or 5-8 patients Visit Duration: 30 min 60 min 90 min if >90 min, indicate total minutes Diagnoses Relevant to the Group Visit Location of Class Nature and Content of Group Visit Objective(s) of the Training Status Update: Medical Condition, Care Progress to Goal, Interventions, and Target Dates Have some level of individualized interaction(BCBSM) All active diagnosis 98962: Education and training for patient self- management for 5–8 patients; each 30 minutes
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