Provider Insider

Clinical Programs

Fall 2019 | Issue No. 7

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:

    • 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.
    • 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.

 

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: