AHA Coding Clinic® for HCPCS - 2012 Issue 4; For your Information
Transitional Care Management
As part of a multi-year strategy exploring the best means to encourage the provision of primary care and care coordination services to Medicare beneficiaries, CMS is adopting the following CPT transitional care management codes in place of the initially proposed HCPCS G-code: CPT code 99495 (Transitional care management services w/moderate medical decision complexity; Face-to-face visit within 14 days) and CPT code 99496 (Transitional care management services w/high medical decision complexity; Face-to-face visit within 7 days). CPT code 99495 includes the following required elements: Communication (direct contact, telephone, electronic) with the patient and/or caregiver within 2 business days of discharge...
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Article Overview
This article covers CMS’s transitional care management policy for Medicare beneficiaries, including the move to CPT-based reporting, the general service setting and timing framework, and interim outpatient payment treatment under the OPPS for a specific year. It is relevant to coders, billing staff, and revenue cycle professionals working with primary care, care coordination, discharge transitions, and hospital outpatient payment policy.
Why This Topic Matters
The article is important because it describes how CMS structured transitional care management reporting and payment for Medicare-covered transitions of care, which affects claims processing and outpatient reimbursement policy.
What You Will Learn
- How CMS framed transitional care management within its broader care coordination strategy
- What general service setting and transition-of-care context the article addresses
- How the article situates these services within interim outpatient payment policy
- Which organizations and payment systems are discussed in connection with the policy
Who Should Read This
- Medical coders
- Outpatient billing staff
- Revenue cycle professionals
- Primary care practices
- Hospital outpatient departments
- Compliance staff
Codes Discussed
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