TCM is a CMS initiative for primary care physicians or specialists, or qualifying non-physician practitioners for care provided to patients discharged from hospitals or other qualifying institutions or facilities. The provider takes over the patient’s care essentially from moment of discharge (zero gap in care) and continues for 30 days.
Transitional Care Management calls for one face-to-face visit and other non-face-to-face visits during the 30 day period. Cases are rated as requiring “moderate decision making” or “high complexity decision making.”
TCM is designed to keep the patient healthy and well-supported to help avoid readmissions, relapses, etc. and by doing so, reduce healthcare costs.
Two TCM-designated CPT codes are used based on the severity of the patient’s situation. Those codes, 99495 and 99496, return reimbursements of $165 and $233 respectively per TCM patient with some slight variations depending on the state, in addition to any other CPTs for those patients.
The practice must have a certified EHR; the Medics EHR from ADS is ideal to use for TCM reporting.
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