Transitional Care Management (TCM) services address the hand-off period between the inpatient and community setting. After a hospitalization or other inpatient facility stay (e.g., in a skilled nursing facility), the patient may be dealing with a medical crisis, new diagnosis, or change in medication therapy. Family physicians often manage their patients’ transitional care.
The two CPT codes used to report TCM services are:
Discharge from any of the following:
Non-physicians must legally be authorized and qualified to provide TCM services in the state in which the services are furnished.
Learn How Coordinated Care Benefits Patients, Quality Payment Program (QPP) Performance and Your Bottom Line
Transitional care management ensures patients who have a high-risk medical condition will receive the care they need immediately after discharge from a hospital or other facility. Learn more about how to get paid for this service.
Read more about transitional care management in the Making Sense of MACRA: Aligning Transitional Care Management (TCM) with the Quality Payment Program (QPP) supplement (PDF)
The AAFP’s advocacy efforts have helped pave the way for Medicare payment for TCM services, giving family physicians an opportunity to be paid to coordinate care for Medicare beneficiaries as they transition between settings. We believe that family physicians should be compensated for the value they bring to their patients by delivering continuous, comprehensive, and connected health care.
As health care moves from volume to value, TCM services will be increasingly important. These services ensure patients receive the care they need immediately after a discharge from a hospital or other health care facility. Continuity of care provides a smooth transition for patients that improves care and quality of life, and helps prevent unnecessary readmission, thereby reducing costs.