This downloadable Transitional Care Management Template for TCM CPT codes 99495 and 99496 includes step-by-step guidance so that you know exactly when you need to follow-up with your patient, as well as which details to include for every face-to-face and non-face-to-face encounter. It was created in collaboration with healthcare compliance expert Dr. Michael Stearns and is ready for you to view immediately.
This is your chance to finally get paid for the TCM services you’ve been offering for free! In fact, you can double your Medicare reimbursement for these services — and this tool can help.
To download this must-have resource, simply complete this online form. There is no cost to you whatsoever, and your free tool will be available for download immediately.
Transitional Care Management Codes Fast Facts
Approximately 66% of Medicare discharges qualify for TCM Services. You can boost your TCM revenue by 2% provided documentation meets requirements for TCM CPT codes 99495 and 99496. This handy Transitional Care Management Template helps staff record all post-discharge communications, visits and services in one place helping you properly code for and get reimbursed for these TCM codes.
TCM CPT codes 99495 and 99496 became effective on January 1, 2013. Medicare patients discharged from a variety of inpatient settings are eligible for TCM services. The patient must be contacted by the practice within 2 business days.
Requirements for TCM Code 99495
- The patient must be seen face-to-face within 14 calendar days
- The encounter needs to demonstrate a moderate level of complexity of medical decision
- Reimbursement averages $185
Essentials for TCM Code 99496
- The patient must be seen face-to-face within 7 calendar days
- The encounter needs to demonstrate a high level of complexity of medical decision
- Reimbursement averages $260
Services Count During This Period
- The 30-day TCM service period extends for 29 days past the discharge date
- Services that need to be provided during the TCM service period include:
- Interactive contact with the patient
- A least one face-to-face visit
- Additional, ongoing non-face-to-face management, unless it is deemed not necessary by the provider
- If the patient is readmitted or dies during the 30-day TCM service period, TCM services cannot be billed. The face-to-face visit, if it occurred, may be billed as an office visit E/M code
Michael Stearns, MD, CPC, CFPC, is a physician informaticist, certified professional coder (CPC), and certified family practice coder (CFPC). He is the CEO and Founder of Apollo HIT, LLC, an organization that provides compliance consulting services and healthcare information technology (HIT).
His company assists organizations with meeting their documentation, compliance, coding, risk adjustment, EHR optimization and other program goals; including performance in quality and efficiency-based incentive programs.