Transitional Care Management Services: What You Need To Know

By Jacqueline Thelian, CPC, CPC-I - Medco Consultants, Inc.

Effective January 1, 2013, The Centers for Medicare and Medicaid Services (CMS) will allow reimbursement for "Transitional Care Management" (TCM) services (99495-99496) provided by physicians and other qualified healthcare professionals (QHP).

This is a major change for CMS who in the past has not allowed reimbursement for non-face-to-face services. Many physicians/QHP who have been providing these services in the past gratuitously will now be able to receive reimbursement for these services.   

CPT code 99495 TCM, moderate complexity, has a national non-facility reimbursement rate of $163.99 (RVU 4.82) and CPT code 99496 TCM, high complexity, has a national non-facility reimbursement rate of $231.36 (RVU 6.80).

As per CPT, Transitional Care Management (TCM) refers to services for an established patient whose medical and/or psychosocial problems require moderate or high complexity decision-making during transitions from a facility to a non-facility setting.