What does CPT code 99496 mean?
Transitional Care Management Services
Codes 99495 and 99496 are used to report transitional care management services. (TCM). These services are for an established patient whose medical and/or. psychosocial problems require moderate or high complexity medical decision making.
What can be billed with 99496?
Code 99496 should be used if the face-to- face visit requires medical decision making of high complexity within seven days; code 99495 should be used if the face-to-face visit requires medical decision making of moderate to high complexity within seven to 14 days (see the code requirements on page 13).
Does 99496 need a modifier?
Per CCI the 99495 or 99496 cannot have a modifier 25 appended, which may be a hint that it is intended to be billed alone. But a 99396 for example can take a modifier 25. So the combination 99396-25 and 99495 may well be acceptable.
Does Medicare pay for 99496?
For code 99496 performed in a non-facility setting, the Medicare payment allowance would be approximately $233.99. In a facility setting, it is approximately $162.
How often can Transitional Care management be billed?
within 30 days
CPT guidance for TCM services states that only one individual may report TCM services and only once per patient within 30 days of discharge. Another TCM may not be reported by the same individual or group for any subsequent discharge(s) within 30 days.
How do you bill transitional care management?
The two CPT codes used to report TCM services are:
- CPT code 99495 – moderate medical complexity requiring a face-to-face visit within 14 days of discharge.
- CPT code 99496 – high medical complexity requiring a face-to-face visit within seven days of discharge.
Can TCM visits be done via telephone?
Given that CPT describes the visit included in TCM as “face-to-face,” we do not advise conducting that visit as a telephone (audio-only) visit.
Can a TCM visit be done via telehealth?
TCM is on Medicare’s list of covered telehealth services. Per Current Procedural Terminology (CPT), CPT codes 99495 and 99496 include one face-to-face (but not necessarily in-person) visit that is not separately reportable.
What qualifies as a TCM visit?
Transitional Care Management (TCM) services address the hand-off period between the inpatient and community setting. After a hospitalization or other inpatient facility stay (e.g., in a skilled nursing facility), the patient may be dealing with a medical crisis, new diagnosis, or change in medication therapy.
Do commercial payers pay for TCM?
Other commercial payers and Medicare Advantage plans may pay for TCM. Commercial payers may have different payment rates for each code. TCM services rendered by a FQHC for a Medicare beneficiary are subject to co-insurance. 99495 Moderate complexity medical decision making during the service period.
Can 99496 be billed alone?
TCM is billed with CPT code 99495 or 99496, either alone or with other payable services. If it is the only service rendered by a FQHC practitioner, it is paid as a stand-alone billable service.
How do you code transitional care?
What are the requirements for Transitional Care Management Services under 99496?
99496 Transitional Care Management Services with the following required elements: 1 Communication (direct contact, telephone, electronic) with the patient and/or caregiver within 2 business days of… 2 Medical decision making of high complexity during the service period 3 Face-to-face visit, within 7 calendar days of discharge More
What is CPT code 99496?
Specifically the CPT definition of 99496 is: 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 Medical decision making of at least high complexity during the service period
What is the CPT code for Transitional Care?
CPT – Transitional Care Management Services (99495-99496) Codes 99495 and 99496 are used to report transitional care management services (TCM). These services are for an established patient whose medical and/or package, modifier 54 is not required. The required contact with the patient or caregiver, as appropriate, may be by the
What are the required elements of transitional care management services (TCM)?
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 Medical decision making of at least moderate complexity during the service period