There is a lot of confusion surrounding reporting for transitional care management (TCM) services. CPT offers the following options to report TCM services:n
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- 99495 – Transitional Care Management services with the following required elements: communication (direct contact, telephone, electronic) with the patient and/or caregiver within 2 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
- 99496 – Communication (direct contact, telephone, electronic) with the patient and/or caregiver within 2 business days of discharge; medical decision making of high complexity during the service period; face-to-face visit, within 7 calendar days of discharge
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nWhen billing for TCM services, the rendering provider must assume all responsibility for the patient’s care post-discharge leaving no gap in care. The rendering provider must deliver care during the patient’s transition back home following discharge. The patient must return to his/her residence following discharge. Authorized community settings include: home, domiciliary, rest home, assisted living facility. TCM cannot be reported if a patient is discharged from one inpatient facility to another inpatient facility, such as a skilled nursing facility. Each patient must meet the complexity requirements for each CPT code (i.e. moderate for 99495 and high for 99496).nnCMS allows TCM services to be reported in the following discharge settings:n
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- Inpatient acute care hospital
- Inpatient psychiatric hospital
- Long-term care hospital
- Skilled nursing facility
- Inpatient rehabilitation facility
- Hospital outpatient observation or partial hospitalization
- Partial hospitalization at a community mental health center
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