98960 CPT code

The 98960 CPT code references one of the clinician's best tools for helping clients progress in therapy and generalize skills: providing individualized education and training.

Summary

• CPT 98960 is used for providing individualized education and training to clients, helping them manage their condition or therapy goals. This education focuses on self-management and empowers clients with the tools to take control of their health.
• The code requires at least 30 minutes of direct, face-to-face education (in person or via telehealth). Proper documentation is crucial, including start/end times, content covered, and client engagement to ensure accurate billing and reimbursement. Enrolling in an insurance billing course for therapists can help providers enhance their knowledge.
• The CPT code applies across various therapy types, including mental health, speech, occupational, and physical therapy. Examples include teaching stress management techniques, articulation practices, or home exercise programs tailored to individual needs.
• Common issues include a lack of a structured curriculum, inadequate documentation, and double-billing with other therapy codes. Clinicians must stay up to date on payer policies to ensure reimbursement eligibility and avoid claim denials. By leveraging an EHR like TheraPlatform for efficient documentation and claim submission, therapists can tackle billing with ease.

The 98960 CPT code represents a clinician providing education and training for client self-management on an individual basis. 

Equipping clients with the knowledge and strategies they need to actively work towards meeting therapy goals can help them improve and transfer skills into their daily lives. Using the correct CPT code is essential for accurate reimbursement. 

Here, we'll break down the definition of CPT 98960. We'll dive into billing requirements, practical uses in therapy, documentation strategies, common pitfalls, and tips to remember.  

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Defining the 98960 CPT Code 

The definition of the 98960 CPT code is: Education and training for client self-management by a qualified, non-physician healthcare professional using a standardized curriculum, face-to-face with a client (individual) every 30 minutes.  

Healthcare providers can use this code when delivering structured, face-to-face education to clients to help them better understand and manage their condition. 

This code specifically focuses on a client's self-management. This means the service aims to equip the client with the knowledge and specialized tools to take control of their behavior or treatment. Think of it as providing your client with a personalized toolkit. 

Billing guidelines for the 98960 CPT Code 

Clinicians using CPT code 98960 must adhere to the time-based billing guidelines for this code. CPT code 98960 requires a minimum of 30 minutes of direct, face-to-face educational service provided to the individual client (in person or through telehealth). 

This dedicated time spent teaching and demonstrating self-management techniques should not be billed separately when the education occurs as part of another evaluation or treatment service. Parent and caregiver education is already included in payment for these services. 

Accurate time tracking is a key component of proper billing. Therapists should document the start and end times of the education and training session, as well as the content covered, to support the claim and demonstrate compliance with coding requirements. 

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Common 98960 CPT code cases in therapy 

CPT code 98960 can be applied to a wide range of scenarios to enhance the therapeutic process for individuals with various needs. Education and training under CPT 98960 can be used in speech, occupational, physical, and mental health therapy. 

Mental health therapy

• Stress management techniques: Educating a client on specialized stress reduction techniques (e.g., relaxation exercises, time management strategies, mindfulness) through a standardized stress management program. 
• Anxiety disorders: Providing structured training in relaxation techniques, cognitive restructuring skills, and mindfulness techniques. 
• Chronic pain management: Client education on coping strategies, gentle exercises, and pacing techniques that provide the client with an active role in functionally managing pain.  

Speech therapy

• Voice therapy: Educating a client on vocal hygiene techniques and strategies for preventing vocal strain. 
• Dysphagia management: Training a caregiver or client to prepare for a modified diet and to teach safe strategies.
• Articulation therapy: Educating parents on prompting strategies to implement during home practice activities to improve the child's articulation of specific speech sounds. 

Occupational therapy

• Activities of Daily Living (ADL) retraining:  Educating a client and their family through a standardized ADL training protocol, on techniques and adaptive equipment for completing ADLs such as bathing, grooming, and dressing

Physical therapy 

• Home exercise program instruction: Following a standardized exercise protocol to educate a client on correctly performing exercises at home to improve strength, balance, and flexibility.

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Documentation and reimbursement tips for the 98960 CPT code 

When billing with the 98960 CPT code, thorough and accurate documentation is crucial for timely reimbursement. 

Here are the key elements: 

1. Time: Document the start and end times of the education and training, and ensure the total duration is at least 30 minutes.  
2. Client goals: Explain the rationale for providing education. 
3. Description of the educational material utilized: Describe the standardized framework (e.g., CBT-based thought logs for self-management of anxiety). 
4. Client response: Note how the client practiced skills or engaged with the material. 

Healthcare providers should ensure they are credentialed with payers as a provider type eligible to bill CPT code 98960. Certain insurers may only allow certain provider license types to use this code. 

To bill the 98960 CPT code, the education must be provided face-to-face. This may include telehealth, though providers should check whether each payer requires a modifier (e.g., GT95) or specific documentation language.  

Challenges and what to avoid with the 98960 CPT code

Although the 98960 CPT code can help with reimbursement for important client education services, providers should consider a few potential hurdles. 

• Lack of a structured curriculum. A standardized, evidence-based, and replicable educational approach must be used to bill this code. 
• Inadequate documentation. Claim denials or audits can occur from a lack of educational content or time documentation. 
• Double-billing alongside therapy codes. Providers should not bill CPT 98960 with individual therapy or assessment codes, as this may constitute double-billing. Services should be separated and documented as distinct. 
• Inconsistent payer policies. Specific payers have limits or do not reimburse CPT 98960. Clinicians should verify payer policies before submitting claims. 

The 98960 CPT code is a valuable tool that allows therapists to provide clients with the knowledge and skills necessary for effective self-management. Understanding the definition of CPT 98960, billing guidelines, documentation requirements, and potential challenges can help providers use this code confidently and receive reimbursement from payers.  

Ongoing training and education on CPT coding can help therapists stay up to date on current codes and billing practices.

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How EHR and practice management software can save you time with insurance billing for therapists

EHRs with integrated billing software and clearing houses, such as TheraPlatform, offer therapists significant advantages in creating an efficient insurance billing process. The key is minimizing the amount of time dedicated to developing, sending, and tracking medical claims through features such as automation and batching. 

What are automation and batching?

• Automation refers to setting up software to perform tasks with limited human interaction.
• Batching or performing administrative tasks in blocks of time at once allows you to perform a task from a single entry point with less clicking.

Which billing and medical claim tasks can be automated and batched through billing software?

• Invoices: Create multiple invoices for multiple clients with a click or two of a button or set up auto-invoice creation, and the software will automatically create invoices for you at the preferred time. You can even have the system automatically send invoices to your clients.
• Credit card processing: Charge multiple clients with a click of a button or set up auto credit card billing, and the billing software will automatically charge the card (easier than swiping!)
• Email payment reminders: Never manually send another reminder email for payment again, or skip this altogether by enabling auto credit card charges.  
• Automated claim creation and submission: Batch multiple claims with one button click or turn auto claim creation and submission on. 
• Live claim validation: The system reviews each claim to catch any human errors before submission, saving you time and reducing rejected claims. 
• Automated payment posting: Streamline posting procedures for paid medical claims with ERA. When insurance offers ERA, all their payments will post automatically on TheraPlatform's EHR.
• Tracking: Track payment and profits, including aging invoices, overdue invoices, transactions, billed services, service providers 

Utilizing billing software integrated with an EHR and practice management software can make storing and sharing billing and insurance easy and save providers time when it comes to insurance billing for therapists.

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Resources

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References

Burks, K., Shields, J., Evans, J., Plumley, J., Gerlach, J., & Flesher, S. (2022). A systematic review of outclient billing practices. SAGE Open Medicine, 10, 20503121221099021. DOI: https://doi.org/10.1177/20503121221099021. 

Romans, B., Nguyen, E., Biddle, M., Paul, A., Rosko, Z., Minaei, A., ... & Robinson, R. F. (2022). Billing and coding: disparities in healthcare provider training. Journal of Allied Health, 51(1), 43-46. DOI: https://www.ingentaconnect.com/content/asahp/jah/2022/00000051/00000001/art00009

Williams, M., Honan, C., Skromanis, S., Sanderson, B., & Matthews, A. J. (2024). Psychological outcomes and mechanisms of mindfulness-based training for generalised anxiety disorder: A systematic review and meta-analysis. Current Psychology, 43(6), 5318-5340. https://link.springer.com/article/10.1007/s12144-023-04695-x