Meredith Posted Mon 08th of February, 2016 11:20:18 AM
We are a family practice and my nurses are wanting to bill 98960 for them teaching the patient about their insulin and how to use their glucometer etc. during their office visit, is this a legit charge?
SuperCoder Answered Tue 09th of February, 2016 05:12:18 AM
Yes, 98960 is a correct billing. You need to check payer policy as well.
In order to bill for DSMT (Diabetes Outpatient Self-Management Training Services) you must have an accredited program through either the ADA or AADE. The billing for DSMT would then be done under the provider number that is the sponsor of the accredited program.
Also, many private payers do not require AADE/ADA recognition in order to bill DSMT, so you need to check with individual payer.
Furthermore, medicare policy states "The program may also include a program coordinator, physician advisory, and other trainers. However, only one person or entity from the program bills Medicare for the whole program.