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CPT codes

Kathy Posted Sun 17th of February, 2019 15:20:31 PM
I don't fully understand CPT codes 99495 and 99496. Medicare states that a face to face contact can be done. It does not state where the face to face contact should be one at. Can a provider perform face to face contact with the patient in the patient's home?
SuperCoder Answered Mon 18th of February, 2019 10:38:42 AM


Codes 99495 and 99496 are used to report transitional care management services (TCM). These services are for a new or established patient whose medical and/or psychosocial problems require moderate or high complexity medical decision making during transitions in care from an inpatient hospital setting (including acute hospital, rehabilitation hospital, long-term acute care hospital), partial hospital, observation status in a hospital, or skilled nursing facility/nursing facility to the patient's community setting (home, domiciliary, rest home, or assisted living). TCM commences upon the date of discharge and continues for the next 29 days. 

TCM services are used when beneficiary's discharge from one of these inpatient hospital settings like inpatient acute care hospital. inpatient psychiatric hospital etc. and following discharge from the settings, the beneficiary must be returned to his or her community setting like home, domicilliary or rest home. The provider can perform face to face contact visit at community setting like home as describe above.

You can also refer to the below link to transitional care management services article available on CMS website.

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/Transitional-Care-Management-Services-Fact-Sheet-ICN908628.pdf

Hope this helps.

Thanks.

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