Getting Paid for Transitional Care Management Services

CMS, AAFP Resources Explain CPT Codes

September 10, 2013 05:30 pm News Staff
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Some family physicians still have questions about how to use two new CPT codes that were created to cover transitional care management (TCM) services. Codes 99495 (moderate complexity) and 99496 (high complexity) went into effect on Jan. 1. To help clear away any remaining confusion, CMS recently posted answers to some of the most frequently asked questions it has received about the TCM codes.

In its document "Frequently Asked Questions About Billing Medicare for Transitional Care Management Services,"( CMS covers a variety of topics, including questions related to

  • rejected or denied claims,
  • reported dates of service, 
  • provision of services by staff members other than physicians, 
  • patient re-admittance during the 30-day TCM period, 
  • patient death prior to the last day of the provision of TCM services, 
  • reporting of and subsequent payment for TCM services provided by more than one physician, and 
  • billing for other health care services provided during the 30-day TCM period.

The new codes are used to report care management services provided to patients following discharge from a hospital, skilled nursing facility or community mental health center; outpatient observation, and partial hospitalization. The codes were included in the 2013 Medicare physician fee schedule final rule.

In March, the AAFP released its own frequently-asked-questions document to assist family physicians(0 bytes) in understanding the intricacies of the codes. At the same time, the Academy created a 30-day TCM worksheet(0 bytes) aimed at helping physicians keep track of important information in the patient's transitional care summary.

Family physicians looking for more guidance would do well to read two entries in Family Practice Management's Getting Paid blog that focus on the TCM codes; the first posted on Nov. 29, and the second on Feb. 12

Related ANN Coverage
Billing for Transitional Care Management Services
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New Tools Clarify Transitional Care Management CPT Codes