Topics covered in this section:
Asthma education, hospital-based
Fully Funded and Medicaid members are eligible for this service. No
authorization is required for payment, however 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 education, hospital-based
Fully Funded and Medicaid members are eligible for this service. No
authorization is required for payment, however 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 99412 for group education
- Use CPT code 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)
Nutritional counseling
Fully Funded and Medicaid members are eligible for this service. No
authorization is required for payment, however PCP referral is encouraged.
- Bill on a UB04 with revenue code 942
- Use CPT code:
-
- 97802: Medical Nutrition Therapy: Initial one-on-one* with the
patient, 15 minutes
- 97803: Medical Nutrition Therapy: Follow-up one-on-one* with the
patient, 15 minutes
- 97804: Medical Nutrition Therapy: Group session, 30 minutes or
more
*Units billed should total the time spent. Example: For 30-minute visits,
bill 2 units.
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
Last modified
11/13/07
