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The CPT® Code 0403T refers to a preventive behavior change program specifically designed for individuals identified as being at risk for developing type 2 diabetes. This program utilizes a standardized diabetes prevention curriculum and is conducted in a group setting. The primary objective of this intensive program is to facilitate behavior modification that can lead to a reduction in the risk of diabetes through lifestyle changes. Participants typically engage in the program for a minimum of 60 minutes each day. The criteria for determining an individual's risk for type 2 diabetes may include factors such as being overweight, with a Body Mass Index (BMI) of 24 or greater (or 22 or greater for individuals of Asian descent), elevated hemoglobin A1C levels ranging from 5.7% to 6.4%, fasting plasma glucose levels between 100 to 125 mg/dL, or results from an oral glucose tolerance test (OGTT) indicating levels from 140 to 199 mg/dL. Additionally, a history of gestational diabetes can also be a significant risk factor. The program emphasizes moderate weight loss through a structured approach that includes a progressive reduction in caloric and fat intake, increased physical activity—aiming for at least 150 minutes of brisk walking per week—and the development of problem-solving and coping skills. A trained lifestyle coach leads the sessions, which may occur weekly to monthly, and encompass education, behavior modification techniques, stress management strategies, and peer support to enhance the participants' ability to make lasting changes in their health behaviors.
© Copyright 2025 Coding Ahead. All rights reserved.
The preventive behavior change program represented by CPT® Code 0403T is indicated for individuals who are at risk for developing type 2 diabetes. The specific criteria for identifying at-risk individuals include the following:
The procedure associated with CPT® Code 0403T involves several key steps aimed at delivering an effective diabetes prevention program. Each step is designed to ensure that participants receive comprehensive support and education throughout the program.
After completing the intensive program associated with CPT® Code 0403T, participants are expected to continue implementing the lifestyle changes they have learned. Ongoing support may be available through follow-up sessions or additional resources to help maintain weight loss and prevent the onset of type 2 diabetes. Participants are encouraged to remain active, adhere to dietary recommendations, and utilize problem-solving skills developed during the program to manage their health effectively. Regular monitoring of blood glucose levels and other health indicators may also be recommended to assess long-term success and prevent complications.
| Short Descr | DIABETES PREV STANDARD CURR | Medium Descr | DIABETES PREVENTION PROG STANDARDIZED CURRICULUM | Long Descr | Preventive behavior change, intensive program of prevention of diabetes using a standardized diabetes prevention program curriculum, provided to individuals in a group setting, minimum 60 minutes, per day | Status Code | Carriers Price the Code | Global Days | XXX - Global Concept Does Not Apply | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 0 - No payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 0 - Payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Non-Covered Service, not paid under OPPS | Berenson-Eggers TOS (BETOS) | M5D - Specialist - other | MUE | 1 |
| GT | Via interactive audio and video telecommunication systems | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. |
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| 2016-01-01 | Added | Added |
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