Transitional care management (TCM) codes 99495 and 99496 were added to Current Procedural Terminology (CPT®) and as a Medicare benefit in 2013. However, provision of these services has been somewhat limited by payer policies that do not support provision of TCM services and lack of practice capabilities to recognize eligible patients and offer the services within the time constraints of the codes. With changes in payment policies and, for many, practice capabilities, it may be worthwhile to revisit the basics of providing and reporting these services.
Codes 99495 and 99496 describe services that include specific elements and time frames.
The first visit (within 7 or 14 days of discharge) is not separately reported when reporting TCM services. However, additional face-to-face encounters during the TCM service period are separately reported.
Before providing the elements of service, physicians should verify that the patient meets criteria for receiving TCM services....