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WEEKEND MAINTENANCE: The maintenance outage is scheduled for June 22nd at 6:00am EST ending NLT Sunday, June 23rd at 11:59pm Eastern EST. The TRICARE Manuals web site may be available intermittently during this period but it's usage is not recommended.

TRICARE Policy Manual 6010.63-M, April 2021
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 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 calendar 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 calendar 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.
3.3  All Current Procedural Terminology (CPT) coding guidelines apply. See Section 1.1.
4.0  EFFECTIVE DATE
January 1, 2013
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