Group visits
Applies to:
Commercial group HMO, POS and PPO plans
Commercial individual MyPriority® plans
Definition
Group visits are shared medical appointments, where a provider or providers meet with patients in a group setting. They can offer an increase in the productivity and efficiency of the health care team and can provide patients with an alternate visit, offering a holistic and therapeutic approach designed to improve patient access to and quality of care through enhanced education and support.
Group visits are most appropriate for:
- Patients needing routine follow-up care
- Stable, chronically ill patients requiring total mind/body care
- Patients who typically require more time with their physician
- Patients who come for frequent return visits
- Patients with extensive emotional, informational, or psychosocial needs
- The "worried well"
The American Academy of Family Practice (AAFP) lists a number of factors that can contribute to the success of group visits:
- Instill hope in patients by allowing them to see examples of success in managing a health issue
- Add universality by disconfirming the uniqueness felt by patients regarding their conditions and/or health issues
- Impart information and allay patient anxiety
- Encourage an unselfish regard for the welfare of others
- Promote imitative behavior and allow for positive role modeling among patient peers
- Offer interpersonal and cognitive learning within the group setting
- Provide group cohesiveness where peers can offer support among themselves
Group visit billing
Priority Health reimburses primary care physicians (PCPs) and qualified health care professionals* (QHPs) fee-for-service for group visits.
- These codes are not payable for members of self-funded or shared-funded plans.
- These codes are not payable for members of Medicare or Priority Health Choice plans (Healthy Michigan Plan and Medicaid).
- No modifier is necessary to bill these codes.
Reimbursement rates
The reimbursement rates for these codes are listed in our standard fee schedules for your contract.
See our standard fee schedules
Group education & training
Providers can bill for education and training using condition-specific codes provided by a qualified health professional (QHP)*.
Billable codes
98961: Group education and training, 2-4 patients, each 30 min.
98962: Group education and training, 5-8 patients, each 30 min.
In addition, 99078, Physician educational services rendered in a group setting, is billable:
- For fully funded and self-funded plan members
- Not separately billable for Medicare or Priority Health Choice plans (Healthy Michigan Plan and Medicaid) patients
- By primary care physicians (PCPs) and QHPs*. The PCP may include other members of the care team (RN, behavioralist, diabetic educator, nutritionist, etc.) in the group setting.
- Report in addition to the E&M service
*QHPs inlcude RNs, certified NPs, PA-Cs, licensed Masters social workers (LMSWs), psychologists (LLPs and PhDs), certified diabetic educators, (CDEs), registered dieticians and Masters'- trained nutritionists, clinical pharmacists and respiratory therapists.