CPT Codes for Case Management, Patient Education, and Other Miscellaneous Services

The following Current Procedural Terminology (CPT® American Medical Association) codes represent supportive or miscellaneous services that supplement or are adjunct to direct patient care. Supportive services, such as case management or patient education services, are designed to enhance or assist a patient with treatment goals or to monitor treatment effectiveness. Miscellaneous services generally provide a means to report the completion of special services that are adjunct to basic treatment and evaluation services, such as completing special reports or providing medical testimony. For virtual services, such as e-visits, virtual check-ins, telephone assessments, and remote monitoring, see ASHA's web page on communication technology-based services.

Medicare does not recognize these codes for billing by audiologists and speech-language pathologists (SLPs). However, other payers may elect to cover them. Before initiating services, always verify coverage directly with the payer and notify patients that they may be responsible for payment of non-covered services. 

On this page:

• Education and Training for Patient Self-Management (98960-98962)
• Medical Team Conferences (99366 and 99368)
• Miscellaneous Services

See also: Virtual Services

Education and Training for Patient Self-Management

Use these codes to report educational and training services to an individual or a group of patients for the purpose of teaching the patient(s) (including caregivers) how to self-manage their condition or disorder. 

98960  Education and training for patient self-management by a qualified, nonphysician health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/family) each 30 minutes; individual patient

98961  2–4 patients

98962  5–8 patients

Criteria

You must meet the following criteria to report the education and training codes:

• Use a standardized curriculum that is consistent with guidelines or standards established or recognized by a health care professional society or association.
• The patient must be present and actively engaged in the education and training. Don't use these codes for education and training of caregivers without the patient present.
• Don't report these codes for patient or caregiver education that occurs as part of another evaluation or treatment service. Patient and caregiver education are bundled into payment for these services and aren't separately billable.
• Follow established guidelines for meeting minimum time requirements for time-based codes. Don't report these codes for services that last 15 minutes or less.

Medical Team Conferences

If you participate in medical team conferences for a patient's care, you may use medical team conference CPT codes to report 30 minute or longer meetings. These should be of special interest to those involved in cleft palate teams, feeding teams, or other medical teams. These codes may not be used to report conferences that are not medical or clinical in nature.

99366 Medical team conference with interdisciplinary team of health care professionals, face-to-face with patient and/or family, 30 minutes or more; participation by nonphysician qualified health care professional

(Team conference services of less than 30 minutes duration are not reported separately)

99368 Medical team conference with interdisciplinary team of health care professionals, patient and/or family not present, 30 minutes or more; participation by nonphysician qualified health care professional

(Team conference services of less than 30 minutes duration are not reported separately)

Criteria

You must meet the following criteria to report the team conference codes:

• A minimum of three qualified health care professionals from different specialties or disciplines who provide direct care to the patient must participate in the reported team conference.
• No more than one individual from the same specialty may report 99366-99368 at the same encounter.
• Reporting participants must be present for the entire team conference.
• Reporting participants shall have performed face-to face evaluations or treatments of the patient, independent of any team conference, within the previous 60 days.
• Follow established guidelines for meeting minimum time requirements for time-based codes. Don't report these codes for services that last less than 30 minutes total.

Reporting participants should record their role in the conference, contributed information, and subsequent treatment recommendations. The time for the team conference starts at the beginning of the case review and ends at the conclusion of the review. Record keeping or report generation time is not included. However, the time is not limited to the time that the participant is addressing the team or patient/family.

Miscellaneous Services

Miscellaneous services generally provide a means to report the completion of special services that are adjunct to basic treatment and evaluation services, such as completing special reports, providing educational materials, or providing medical testimony. Most payers do not recognize these services for billing, unless specifically indicated in coverage policies. For example, supplies and materials are typically bundled with the service/procedure and are not separately payable. In addition, your contract with payers may prohibit you from directly billing patients for these services. Please check with payers regarding coverage of these services.

99056  Service(s) typically provided in the office, provided out of the office at request of patient, in addition to basic service

99070  Supplies and materials (except spectacles), provided by the physician or other qualified health care professional over and above those usually included with the office visit or other services rendered (list drugs, trays, supplies, or materials provided) (For additional supplies, materials, and clinical staff time required during a Public Health Emergency, as defined by law, due to respiratory-transmitted infectious disease, use 99072)

99071  Educational supplies, such as books, tapes, and pamphlets, for the patient’s education at cost to physician or other qualified health care professional

99072  Additional supplies, materials, and clinical staff time over and above those usually included in an office visit or other non-facility service(s), when performed during a Public Health Emergency, as defined by law, due to respiratory-transmitted infectious disease  

99075  Medical testimony

99080  Special reports such as insurance forms, more than the information conveyed in the usual medical communications or standard reporting form (Do not report 99080 in conjunction with 99455, 99456 for the completion of Workmen’s Compensation forms)

Criteria

You must meet the following criteria to report the miscellaneous services codes:

• Report these codes in addition to the CPT code representing the associated evaluation or treatment service provided during the patient encounter. These are not standalone codes.
• 99056: Use to indicate that the patient specifically requested the location where the service was provided, which is not the typical setting the clinician provide services. For example, a parent may request that a private practice clinician provide services in the patient's natural setting, such as in the school or home. Be sure to verify payer policies and state regulations regarding place of service.
• 99070: Use to report supplies provided by the clinician over and above those usually included with the service provided. Do not report this code for supplies and materials that are typically used to provide a service. In addition, payers may require audiologists and SLPs to use HCPCS Level II codes to report supplies and equipment instead of this CPT code.
• 99071: Use to report those educational supplies that are purchased by the clinician to provide educational resources over and above those that are typically supplied during evaluation or treatment. For example, a clinician may provide an educational pamphlet to teach a patient how to use a specific device. However, do not report this code for supplies and materials that are typically used to provide a service.
• 99072: Use this code to report the cost of additional personal protective equipment (PPE), cleaning supplies, and clinician or clinical staff time needed to safely provide in-person services during a respiratory-transmitted public health emergency (PHE). See ASHA's website for additional details on how to use this code.
• 99075: Use to report time spent providing testimony in the judicial system. Do not bill this code to a government or commercial insurers. It is typically used to bill attorneys or others who may request medically-related depositions or testimony.
• 99080: Use to report those times a clinician completes reporting over and above standard reporting, such as detailed reports related to accidents or worker's compensation forms. Do not report this code for standard activities, such as filling out claim forms, writing a treatment note, or completing evaluation and discharge reports.