Transitional Care Management (TCM) services address the hand-off period between the inpatient and community
setting. After a hospitalization or other inpatient facility stay (e.g., in a skilled nursing facility), the patient may be
dealing with a medical crisis, new diagnosis, or change in medication therapy.
Transitional Care Management (TCM) services address the hand-off period
between the inpatient and community setting. After a hospitalization or
other inpatient facility stay (e.g., in a skilled nursing facility), the patient may
be dealing with a medical crisis, new diagnosis, or change in medication
therapy.
FAQs
Transitional Care Management (TCM)
Billing Codes
You must provide 1 face-to-face visit within the timeframes described by these 2 CPT codes:
- 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 —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 high complexityduring the service period; Face-to-face visit, within 7 calendar days of discharge
What are the requirements for patient qualification?
Required patient transitional care management (TCM) services include:
- Supporting a patient’s transition to a community setting
- Health care professionals who accept patients at the time of post-facility discharge, without a service gap
- Health care professionals taking responsibility for a patient’s care
- Moderate or high complexity medical decision making for patients with medical or psychosocial problems
The 30-day TCM period begins on a patient’s inpatient discharge date and continues for the next 29 days. TCM services begin the day of discharge from 1 of these inpatient or partial hospitalization settings:
- Inpatient acute care hospital
- Inpatient psychiatric hospital
- Inpatient rehabilitation facility
- Long-term care hospital
- Skilled nursing facility
- Hospital outpatient observation or partial hospitalization
- Partial hospitalization at a community mental health center
After inpatient discharge, the patient must return to their community setting. These could include:
- Home
- Domiciliary (such as a group home or boarding house)
- Nursing facility
- Assisted living facility
What documentation is required?
- Patient discharge date
- Patient or caregiver first interactive contact date
- Face-to-face visit date
- Medical complexity decision making (moderate or high)