As is often the case, the Centers for Medicare & Medicaid Services (CMS) does not totally agree with Current Procedural Terminology (CPT®) instructions for providing and reporting transitional care management (TCM) codes 99495 and 99496. In the final rule addressing 2013 Medicare Physician Fee Schedule changes, the CMS agreed to add Medicare benefits for the new CPT codes rather than a previously proposed Healthcare Common Procedure Coding System Level II G code and agreed to mostly adhere to CPT instructions for reporting TCM. The differences between the Medicare rule and CPT will once again require that physicians and their staff recognize those Medicaid plans and private payers who adopt the Medicare rules and report TCM services accordingly. The following summarizes these differences:

Regardless of the rules you must follow, TCM services offer an opportunity to gain payment for providing good care to patients transitioning home from an...

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