2020 CMS Code Updates: Transition Care Management (TCM)

December 11, 2019

TCM services reduced readmission rates, lowered mortality, and decreased health care costs. With the added value of this program, the reimbursement rates will be increasing. 

Orb Health

Once a patient walks out of the automatic doors of an emergency room or hospital, the chances of a primary care provider or specialist follow-up begins to decrease. Thankfully, further support is coming our way in 2020.

Centers for Medicare and Medicaid Services (CMS) provide additional accessibility to patients during transitional care periods and are allowing for concurrent billing with Chronic Care Management code 99490With a Transitional Care Management (TCM) program, patients may be identified for Chronic Care Management (CCM) qualification for continued support past their transitional care period. As a chronically ill patient, the vital impact we will see with the option to bill TCM and CCM concurrently is the continuity of care for our sickest population. 

 CMS finds that the utilization of TCM is low compared to the number of Medicare discharges and that TCM services reduced readmission rates, lowered mortality, and decreased health care costs. With the added value of this program, the reimbursement rates will be increasing. 

 99495, TCM: 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 

  • 99495 – $175.76 
  • RVU: 2.11 

99496, TCM: Communication (direct contact, telephone, electronic) with 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. 

  • 99496 – $237.11 
  • RVU: 3.05 

 TCM is a key tool in reducing preventable readmissions and connecting the entire care team from the inpatient care setting back to their primary care provider. With the ability to bill CCM and TCM within the same month, it helps prevent a disconnect between TCM and CCM care staff and encourage warm hand-offs between both teams for more connected focused care.  

 

Unfortunately, RHCs and FQHCs may not bill concurrently with CCM.