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: C-100, August 3, 2022
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 services; however, the
telephone service is incidental or in support of the medically necessary
and appropriate primary service.
4.0 EFFECTIVE DATE
January 1, 2013
- END -