Commercial group HMO, POS and PPO plans
Commercial individual MyPriority® plans
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.
The reimbursement rates for these codes are listed in our standard fee schedules for your contract.
Group education & training
Providers can bill for education and training using condition-specific codes provided by a qualified health professional (QHP)*.
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.