Back to top

Transitional Care Management Codes Included in Final Rule

Coding Corner

The information provided here applies to Medicare coding. Be sure to check with your Medicare Administrative Contractor (MAC) for additional information and clarification on these and other items. You should also contact your local insurance carriers to determine if private insurers follow Medicare's lead on all coding matters.

Transitional Care Management Codes Included in Final Rule
The Centers for Medicare and Medicaid Services announced payment and policy changes under the Medicare Physician Fee Schedule on November 1. Included in the final rule is a policy to pay a patient’s physician to coordinate care in the 30 days following a hospital or skilled nursing facility discharge by utilizing Current Procedural Terminology (CPT) codes 99495 and 99496. Following is a summary of the required elements as provided for in the final rule:

  • 99495 Transitional Care Management Services
    • Communication (direct contact, telephone, electronic) with the patient and/or caregiver within two 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
    • Communication (direct contact, telephone, electronic) with the patient and/or caregiver within two business days of discharge.
    • Medical decision making of high complexity during the service period.
    • Face-to-face visit within seven calendar days of discharge.