Do You Understand the New Medicare Transitional Care Management Service Codes?
Effective January 1, 2013, Medicare and other payers will pay for two new CPT codes (99495 and 99496) that are used to report physician or qualifying non-physician practitioner transitional care management (TCM) service for patients, following a discharge from a:
- Hospital
- Skilled Nursing Facility (SNF)
- Community Mental Health Center (CMHC)
- Outpatient observation
- Partial hospitalization
and including a transition to:
- Home
- Domiciliary
- Rest Home
- Assisted Living
These two codes require the medical decision-making to be of moderate to high complexity. Each code encompasses one face-to-face visit and non face-to-face services, for instance, arranging home health agencies for patient care.
Codes are selected based on medical decision-making associated with the patient’s condition, the time when the communication is initiated with the patient, and the time when the face-to-face encounter occurs following discharge. The first face-to-face encounter is included. The codes may be reported only once per 30 calendar days. See the full code description at the end of this article.
