Summary & Overview
HCPCS S9460: Diabetic Management Program, Nurse Visit
HCPCS Level II code S9460 denotes a nursing visit delivered as part of a diabetic management program. This code captures nursing-led services focused on diabetes self-management education, monitoring, medication reconciliation, and care coordination outside of a typical physician visit. Nationally, codes for structured diabetes management are important for capturing the role of allied health professionals in chronic disease management and for aligning payment with team-based care.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for S9460, expected sites of service, and common operational considerations for documenting a nurse-led diabetes management visit. The publication highlights where this code fits within ambulatory and home-based diabetes programs and outlines what data is available and what is not available in the input.
The piece provides benchmarks and policy-relevant context where available, notes common modifiers used with this service (input provided), and flags gaps in associated taxonomies, ICD-10 mappings, and related codes when those details are not provided. The goal is to give payers, billing staff, and program managers a clear, national-level summary of HCPCS Level II code S9460 and the practical contexts in which it is used.
Billing Code Overview
HCPCS Level II code S9460 represents a diabetic management program, nurse visit. This service involves nursing-led diabetes management activities such as education, glucose monitoring, medication management support, and care coordination provided as part of a structured diabetes program.
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Service type: Nursing visit for diabetes management
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Typical site of service: Outpatient clinic, community health center, home health visit, or other ambulatory program settings
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient is a middle-aged adult with type 2 diabetes mellitus attending a diabetic management program nurse visit billed with S9460. The patient presents to an outpatient clinic or community health center for scheduled follow-up focusing on diabetes self-management. The nurse reviews home glucose logs, assesses medication adherence, checks vital signs including weight and blood pressure, performs foot inspection, provides diabetes education (diet, glucose monitoring, lifestyle), and adjusts counseling based on recent hemoglobin A1c results. Basic point-of-care testing such as capillary blood glucose may be performed; venipuncture for laboratory testing (for example, hemoglobin A1c) is arranged if indicated. The encounter is typically documented in the outpatient clinic chart; the nurse documents education provided, self-management goals set, referrals (diabetes educator, nutritionist, podiatry) and communicates recommendations to the primary care provider or supervising clinician. This procedure commonly occurs in ambulatory clinic exam rooms, community health centers, patient homes under home health programs, and federally qualified health centers. Typical visit length ranges from 15 to 45 minutes depending on complexity and education needs. Follow-up scheduling is based on glycemic control and comorbid conditions.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier/standard reporting |