REMINDER: Transitional Care Management Services (TCM)
Billing TCM Services
- Only 1 physician or NPP may report TCM services.
- Report services once per patient during the TCM period.
- The same health care professional may discharge the patient from the hospital, report hospital or observation discharge services, and bill TCM services. The required face-to-face visit can’t take place on the same day you report discharge day management services.
- Report reasonable and necessary E/M services (except the required face-to-face visit) to manage the patient’s clinical issues separately.
- You can’t bill TCM services within a post-operative global surgery period (we don’t pay for TCM services if any of the 30-day TCM period falls within a global surgery period for a procedure code billed by the same practitioner).
- At a minimum, document this information in the patient’s medical record:
- Patient discharge date
- Patient or caregiver first interactive contact date
- Face-to-face visit date
- Medical decision making (moderate or high)
TCM services include both face-to-face visits and non-face-to-face services. These health care practitioners can provide services associated with face-to-face TCM services and can supervise auxiliary personnel (including clinical staff). TCM codes are care management codes. Auxiliary personnel may assign them for TCM non-face-to-face services under the general supervision of the physician or NPP subject to applicable state law, scope of practice, and the Medicare Physician Fee Schedule incident to rules and regulations. Auxiliary personnel may provide these non-face-to-face TCM services under Physician or NPP general supervision.
Face-to-Face Visit
You must provide 1 face-to-face visit within the timeframes described by these 2 CPT codes:
- 99495 — Transitional care management services with the following required elements: Communication (direct contact, telephone, electronic) with the patient and/or caregiver within 2 business days of discharge At least moderate level of medical decision making during the service period Face-to-face visit, within 14 calendar days of discharge
- 99496 — Transitional care management services with the following required elements: Communication (direct contact, telephone, electronic) with the patient and/or caregiver within 2 business days of discharge High level of medical decision making during the service period Face-to-face visit, within 7 calendar days of discharge
Do not report the TCM face-to-face visit separately.
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