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Notice 3/10/11
Commission Rescinds Previous Action on Chronic Disease Self-Management Education
At the January 2011 Health Services Commission meeting, the Commission voted (10-0) to add the following chronic disease self-management education procedure codes to 6 chronic disease lines:
98960 (Education and training for patient self-management by a qualified, non-physician health care professional using a standardized curriculum, face-to-face with the patient, can include caregiver/family, each 30 minutes; individual patient); 98961 (2-4 patients) and 98962 (5-8 patients) to lines:
  • 9 Major Depression, Recurrent
  • 11 Asthma
  • 12 Hypertension And Hypertensive Disease
  • 33 Type II Diabetes Mellitus
  • 108 Heart Failure
  • 195 Chronic Ischemic Heart Disease
At the HSC meeting on March 10, 2011, staff from the Division of Medical Assistance Programs (DMAP) brought forward concerns regarding feasibility of implementing the approved Commission’s decision.
Under the Oregon Health Plan (OHP), most chronic disease management services that would be billed under these codes would be provided in a Federally Qualified Health Center (FQHC). Due to federal rules, OHP cannot reimburse FQHC’s for these services without paying the full encounter rate for each patient who participates in such an education program for each session. Under this reimbursement structure, it would not be cost effective to provide these services under the Oregon Health Plan. The Commission’s intent would be to cover such services if an appropriate reimbursement arrangement could be reached. However, in the absence of such an arrangement, the Commission voted (7-0) not to add CPT codes 90960-98962 to the Prioritized List effective April 1, 2011 and recommend that DMAP place these codes in its Excluded File.