ALERT!!
MONTHLY MAINTENANCE: The DHA network is scheduled for monthly maintenance on Saturday, May 21st at 6:00am (EST) until Sunday, May 22nd at 11:59pm (EST). The TRICARE Manuals web site may be available intermittently during this period but its usage is not recommended.
Administration
Chapter 1
Section 14.1
Transitional Care Management
Services
Issue Date: January 16, 2015
Copyright: CPT
only © 2006 American Medical Association (or such other date of
publication of CPT). All Rights Reserved.
Revision:
1.0 CPT
procedure CODES
99495, 99496
2.0 DESCRIPTION
2.1 Transitional
care management services are for new or established patients whose
medical or psychological problems require moderate or high complexity
medical decision making during transitions in care from an inpatient
setting, partial hospital, observation status or Skilled Nursing Facility
(SNF) to the patient’s community setting.
2.1.1 99495 - Transitional Care
Management Services
• Communication (direct
contact, telephone, electronic) with the patient and/or caregiver
within two business days of discharge.
• Medical decision making
of at least moderate complexity during the service period.
• Face-to-face visit,
within 14 calendar days of discharge.
2.1.2 99496 -
Transitional Care Management Services
• Communication (direct
contact, telephone, electronic) with the patient and/or caregiver
within two business days of discharge.
• Medical decision making
of high complexity during the service period.
• Face-to-face visit,
within seven calendar days of discharge.
2.2 Transitional
care management is a bundle of services provided within a 30-day
period following discharge. The required elements include communication
with the patient (direct, telephonic or electronic), medical decision
making, and a face-to-face visit.
3.0 POLICY
3.1 Transitional
care management services are covered by TRICARE one time per beneficiary
within 30 days of discharge.
3.2 Telephone services may be
provided as part of these codes which represent a bundle of service; however,
the telephone service is incidental or in support of the medically
necessary and appropriate primary service. As a result, the TRICARE
exclusion for services and advice provided by telephone does not
apply.
4.0 EFFECTIVE
DATE
January 1, 2013
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