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transitional care management

Mastering Transitional Care Management Codes Can Transform Revenue Flow

As a practitioner, it is essential to meet your patient’s needs and ensure that they are free of pain and problems. As a result, transitional care gives you the chance to provide patients with guidance and care even after they have been discharged. Beginning on the day the patient is released from the hospital, transition care takes place over the next thirty days. The two fundamental advantages are that we can reduce the number of patients in the hospital bed and furthermore plan patients for a smooth return once more into their ordinary lives.

To provide the best treatment possible, you must first get to know your patients. Knowing the CPT codes for Transitional Care Management (TCM) enables you to plan ahead of time.

After reading this blog, you will have a better understanding of TCM coding standards and requirements.

Who Is Eligible For Payments?

Medical Personnel who can apply and Bill TCM Services:

  • Physicians (any specialty)
  • Clinical Nurse Specialist (CNS)
  • Nurse Practitioner (NP)
  • Physician Assistant (PA)
  • Qualified Nurse Midwife

Transitional care management treatments can be done through in-person visits or non-face-to-face visits.

Do You Know about Medical Decision-Making?

Before heading on with codes applicable for transition care, you need to know about medical decision-making.

Medical decision-making will determine the code relevant to the patients. So, what exactly is medical decision-making? If you’re curious about it. We have explained it briefly below.

It refers to the difficulty in determining the care. Factors that influence the decision-making are:

  • No. of diagnosis options and care management choices.
  • Complications in the medical and diagnosis data must be analyzed.
  • Complications related to the patient’s health and morbidity related to the patient’s diagnosis and treatment management. 

Codes To Use In Face-to-Face Visit

When providing personal support to patients who are discharged from the hospital setting, Use the following two codes and stick to their particular requirements.

CPT Code 99495 

When you interact with the patients over the phone or in person, you can claim using this code.

This code only applies to services provided within 14 days of discharge and for a patient with a moderate medical complexity.

CPT Code 99496

When you interact with the patients over the phone or in person, you can claim using this code.

This code only applies to services provided within 7 days of discharge and for a patient with high medical complexity.

CPT codes 99495 and 99496 can be filed for telehealth services and apply to both new and established patients.

What Else To Look Upon?

Other things to consider when using the two previously stated codes.

  1. Medication reconciliation and management should happen no later than the face-to-face visit.
  2. Personal examination as part of the care management process.
  3. Determining the need for medical tests and keeping track of their results.
  4. Examining the discharge records.
  5. Having a clear reconciliation before the visits. (In-person visits) 

What Can You Get?

TCM billing payments can be beneficial to long-term medical facilities. By providing high-quality care, you can reduce readmissions. By comprehending TCM guidelines, we can increase revenue and financial flow for your practice.

Assume that the average monthly expense for a patient receiving moderate complexity care is $176.50, while the average monthly expense for high complexity care is $236.77. These financial benefits are available to caregivers who guarantee fewer readmissions.

What Are The Latest Rules?

Chronic Care Management (CCM) can be billed along with transitional care management.

Formerly, Medicare policy restricted reimbursement for both CCM and TCM treatments in the same month for the same patient. However, Medicare now accepts double payments for both treatments when they are reasonable and medically required for the patient.

Why Should TCM Codes Be Prioritized?

TCM codes offer higher rates of reimbursement than typical evaluation and management codes. Furthermore, these codes offer greater work relative value units (used in billing).

In addition to the potential of higher reimbursement, TCM services can show cost savings through other metrics measurements. TCM treatments may reduce the 30-day readmission rates.


There are distinct requirements for each code. Clinical coding is a craftsmanship that, when done accurately, draws in payers. If something goes wrong, the payers move on to the next paper.

Managing inpatient and outpatient coding, as well as ensuring error-free validation will be on your to-do list.

At the point when you work close by Practolytics, we decide the best way to deal with meet your coding and RCM prerequisites.


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