Military Health System

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.

2.2  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.

3.1  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.