CPT Code 98960: Education and Training for Patient Self-Management, Individual

What is individual self-management education?

CPT 98960 is the code for delivering education and training to help your patients manage their health conditions more effectively. It’s used when a qualified non-physician healthcare professional like a registered nurse, dietitian, or certified diabetes educator, spends at least 30 minutes face-to-face with a patient, and possibly their caregiver or family, using a standardized curriculum.

This could involve teaching about disease processes, medication adherence, symptom tracking, or lifestyle adjustments. This code is often used in chronic care management, asthma action plans, or other self-management training programs.

These kinds of patient education services can significantly improve patient outcomes, especially when patients are empowered to actively participate in their own care. Hence, if you’re delivering structured, individualized education that supports long-term condition management, CPT 98960 is the specific code to report.

CPT code 98960 documentation requirements

Thorough documentation is essential to show that the service was medically necessary and properly delivered. Your documentation should include:

• Patient condition and reason for self-management education: This includes the diagnosis or chronic condition (e.g., diabetes, asthma) and explains the skilled nature of the service and why it was necessary
• Topics covered: List the specific subjects discussed, such as medication use, symptom monitoring, diet, or lifestyle changes
• Time spent: Record the total time spent in 30-minute increments, as CPT 98960 is billed per each 30-minute unit
• Provider credentials and method of instruction: Document that the education was provided by a qualified non-physician healthcare professional (e.g., RN, dietitian, certified diabetes educator) using a standardized curriculum
• Patient response and understanding: Note how the patient responded to the session, their level of engagement, and any evidence of improved understanding or ability to manage their condition

Including these details in your records supports proper coding, reimbursement, and the overall impact of your patient education services.

CPT code 98960 billing guidelines

Maximizing reimbursement requires adhering to specific guidelines to ensure your claim is accurate and compliant. Keep these billing strategies in mind:

• Each unit represents 30 minutes of face-to-face time spent with the patient and this code applies to one-on-one sessions; do not use it for group sessions.
• Instruction must follow a standard curriculum that aligns with clinical guidelines or is recognized by a professional health care society or association.
• The session must involve the patient directly; caregiver-only sessions without the patient present are not billable. If education or training is provided as part of another evaluation or treatment, it’s considered bundled and cannot be billed separately.
• Check coverage rules. CPT 98960 is not typically covered by Medicare unless part of a recognized program like diabetes self-management training (DSMT), but it may be reimbursed by private payers, depending on individual plan policies.

Following these guidelines helps avoid denials and ensures accurate reporting of patient education services.

Other relevant codes

For group education sessions, you may refer to these specific CPT codes:

• 98961: Education and training for patient self-management by a qualified, non-physician health care professional using a standard curriculum, face-to-face with patient/caregiver for 30 minutes each (2-4 patients)
• 98962: Education and training for patient self-management by a qualified, non-physician health care professional using a standard curriculum,m face-to-face with patient/caregiver for 30 minutes each (5-8 patients)