The CPT codes used for patient education are the same codes that are used for many types of consultations and office visits. The offices that have had the most success with reimbursement have worked with their billing departments to answer the following questions:

1. What CPT codes can be used to bill for time spent with a patient when services are provided by a healthcare professional under the supervision of an MD?
2. What is our level of reimbursement for these codes?
3. Can a Nurse Practitioner (NP) or Physician Assistant (PA) bill under his/her own name? If so, what CPT codes are used?
4. How do we currently bill for the time our nurses spend with patients?
5. How do we interpret "incident to" regulations at our hospital/practice? That is, what types of healthcare providers can bill "incident to" a physician?
6. If we bill under "incident to" guidelines, what MD involvement is needed in the office visit/consultation? (e.g. needs to actually see the patient, must be present in the office for questions, etc.)

This is not an exhaustive list, but merely some of the most commonly asked questions. There may be other questions you may have that are unique to your situation.

For a partial list of CPT and ICD.9 codes that offices have used to bill for patient education services, click here (pdf).

Note: We have provided examples of possible codes to use for billing. We have not provided the complete list of codes nor their descriptors. We are not suggesting that these are the codes you should use - they are only potential examples. The codes provided are not meant to substitute for the complete listing of codes. This information may be dated. All codes used should be patient specific and must be valid at the the time the test is ordered. Codes and reimbursement may be dependent of the state in which you live, the payor and the level of healthcare professional providing the services.

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