Transitional Care Management (TCM) encompasses the 30 days of a Medicare beneficiary’s post-discharge period from an inpatient acute care or psychiatric hospital, long-term care hospital, skilled nursing facility or inpatient rehabilitation facility. It focuses on helping the patient make a seamless transition between the inpatient setting and outpatient care. Its focus is to avoid readmissions and hand off the patient’s care to his/her primary care team.
CMS covers TCM services, which include interactive contact with the patient within two business days of discharge from an inpatient facility; one face-to-face (F2F) visit with the healthcare practitioner to incorporate new care regimens or changes to existing care plans; and all coordination and management of the patient’s care needs during the post-discharge period.
TCM is billed after the 30th day post-discharge.
- If the patient’s F2F visit occurred within seven calendar days of discharge, 99496 is billed.
- If the F2F visit occurred 14 calendar days after discharge, 99495 is billed.
- F2F visits can be done via telehealth, audio & visual only, during the public health emergency.
Check with your commercial payors to know if they also cover TCM services and any specific codes or guidelines.