Transitional care management coding requirements

Transitional care management (TCM) ensures the safe handoff of patients from one care setting to another, such as from hospital to home. The CPT codes for TCM require one face-to-face visit, certain non-face-to-face services, and medication reconciliation and management during the 30-day service period.

Code 99495 has the following requirements:

• Communication (direct contact, telephone, or electronic) with the patient or caregiver within two business days of discharge,
• Medical decision making of at least moderate complexity during the service period,
• A face-to-face visit within 14 days of discharge.

Code 99496 has the following requirements:

• Communication (direct contact, telephone, or electronic) with the patient or caregiver within two business days of discharge,
• Medical decision making of high complexity during the service period,
• A face-to-face visit within seven days of discharge.

Read the full FPM article: “Transitional Care Management: Practical Processes for Your Practice.”