Billing for education services
Asthma counseling, hospital-based
Fully funded and Medicaid members are eligible for this service. For participating providers no authorization is required for payment. PCP referral is encouraged.
- The office visit copayment applies for fully funded members, but not for Medicaid members.
- One visit per benefit year is allowed
- Bill on a UB04 using revenue code 942.
- Use CPT code 99404 for one-on-one education.
- Use diagnosis code 493.90.
Diabetes counseling, hospital-based
Fully funded and Medicaid members are eligible for this service. For participating providers, no authorization is required for payment. PCP referral is encouraged.
- The office visit copayment applies for fully funded members, but not for Medicaid members.
- Bill on a UB04 using revenue code 942.
- Use CPT code 99411-99412 for group education.
- Use CPT code 99401-99404 for one-on-one education.
- Use diagnosis code range of 250.00 to 250.93.
- When provided by a dietitian during the diabetes education class, nutritional counseling can be billed separately (see below)
Nutrition counseling
Fully funded and Medicaid members are eligible for this service. For participating providers, no authorization is required for payment. PCP referral is encouraged.
Go to the Provider Manual page on billing for nutrition counseling.
Use diagnosis codes:
- Asthma 493.00 to 493.32
- Cardiomyopathy 425.0, 425.9
- Congestive Heart Failure CHF 428.0 to 428.9
- Coronary Artery Disease CAD 414.00 to 414.8, MI 410.00 to 410.92
- Diabetes 250.00 to 250.93
- Hypercholesteremia 272.0
- Hypertension 401.0 to 401.9
- Stroke CVA430 to 434.91
