Transitional care management (TCM) FAQs.
Q: What current procedural terminology (CPT) codes do I use to report TCM?
A: There are two CPT codes that may be used:
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- 99495 Transitional Care Management Services with the following required elements:
- Interactive contact via phone, email, or in person with patient and/or caregiver within two business days of discharge.
- Medical decision making of at least moderate complexity.
- Face-to-face visit within 14 calendar days of discharge.
- 99495 Transitional Care Management Services with the following required elements:
-
- 99496 Transitional Care Management Services with the following required elements:
- Interactive contact via phone, email, or in person with the patient and/or caregiver within two business days of discharge.
- Medical decision making of high complexity.
- Face-to-face visit within seven calendar days of discharge.
- 99496 Transitional Care Management Services with the following required elements:
Q: Why shouldn’t I just bill an office visit instead (e.g., CPT 99214)?
A: Code 99214 represents the second-highest level of care for established office patients with a reimbursement of $108 and a 1.5 RVU. Comparatively, CPT 99495 reimbursement is $168 and a 2.11 RVU, and CPT 99496 is $237 and a 3.05 RVU.
Q: What is required to document in the patient’s medical record?
A: At minimum, the following is required:
- Date the patient was discharged.
- Date of the interactive contact with patient or caregiver.
- Date of the face-to-face visit.
- Complexity of medical decision making (moderate or high).
For more information on medical decision making, please refer to this summary table:
