Transitional Care Management

The new 2013 Medicare Physician Fee Schedule includes transition care management (TCM) codes that allow for reimbursement of the non-face-to-face care provided when patients transition from an acute care setting back into the community. 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 new codes are:

CPT Code 99495 – Moderate Complexity – Covers communication with the patient or caregiver within two business days of discharge. This can be done by phone, e-mail, or in person. It involves medical decision making of at least moderate complexity and a face-to-face visit within 14 days of discharge. The location of the visit is not specified.

CPT Code 99496 – High Complexity – Covers communication with the patient or caregiver within two business days of discharge. This can be done by phone, e-mail, or in person. It involves medical decision making of high complexity and a face-to-face visit within seven days of discharge. The location of the visit is not specified.


General Information, Guides, Articles & FAQs

AAFP’s Getting Paid for Transitional Care –
http://www.aafp.org/news-now/practice-professional-issues/20130910tcmfaq…

Transitional Care Management Worksheet –
http://www.aafp.org/content/dam/AAFP/documents/practice_management/payme…

Transitional Care Management FAQs –
http://www.aafp.org/dam/AAFP/documents/practice_management/payment/TCMFA…

Review of CCNC’s Transitional Care Program in HealthAffairs-
http://content.healthaffairs.org/cgi/content/full/32/8/1407?ijkey=10uuiQ…


North Carolina Programs

Community Care of NC’s Transitional Care Program – https://www.communitycarenc.org/population-management/transitional-support/
CCNC’s Transitional Care Program Model – https://www.communitycarenc.org/media/related-downloads/transitional-car…