BC Advantage - 2013 Issue 4

Transitional Care Management Services: What You Need To Know

By Jacqueline Thelian, CPC, CPC-I - Medco Consultants, Inc.Effective January 1, 2013, The Centers for Medicare and Medicaid Services (CMS) will allow reimbursement for "Transitional Care Management" (TCM) services (99495-99496) provided by physicians and other qualified healthcare professionals (QHP).This is a major change for CMS who in the past has not allowed reimbursement for non-face-to-face services. Many physicians/QHP who have been providing these services in the past gratuitously will now be able to receive reimbursement for these services.   CPT code 99495 TCM, moderate complexity, has a national non-facility reimbursement rate of $163.99 (RVU 4...

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