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
- END -