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Face to Face definition for "99495 & 99496" TCM

Brad Posted Tue 25th of June, 2019 00:34:18 AM
To claim against code 99495 or 99496 have 3 requirements 1. Make initial contact with the patient within 2 days post discharge 2. Education & assessment of the patient 3. Face to face visit with the patient within 7 or 14 days depending on severity. Can the the 3rd requirement be extended to a telehealth medium as in a web conferencing call instead of in-person face-to-face meeting? If so, how would this be reported back to medicare to be claimed?
SuperCoder Answered Tue 25th of June, 2019 03:27:05 AM

Hi,

Thanks for your question.

As per CMS, for Face-to-Face Visit requirement: 

You must furnish one face-to-face visit within certain timeframes described by the following two Current Procedural Terminology (CPT) codes:

● CPT Code 99495 – Transitional Care Management services with the following required elements: Communication (direct contact, telephone, electronic) with the patient and/or caregiver within 2 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

● CPT Code 99496 – Transitional Care Management services with the following required elements: Communication (direct contact, telephone, electronic) with the patient and/or caregiver within 2 business days of discharge; Medical decision making of high complexity during the service period; Face-to-face visit, within 7 calendar days of discharge. You should not report the TCM face-to-face visit separately.

1.  You may furnish CPT codes 99495 and 99496 via telehealth. Medicare pays for a limited number of Part B services a physician or practitioner furnishes to an eligible beneficiary via a telecommunications system. Using eligible telehealth services substitutes for an in-person encounter.

2. For billing and payment of telehealth services submit professional telehealth service claims using the appropriate CPT or HCPCS code. If telehealth services are performed “through an asynchronous telecommunications system”, add the telehealth GQ modifier with the professional service CPT or HCPCS code. You are certifying the asynchronous medical file was collected and transmitted to you at the distant site from a Federal telemedicine demonstration project conducted in Alaska or Hawaii. Submit telehealth services claims, using Place of Service (POS) 02-Telehealth, to indicate you furnished the billed service as a professional telehealth service from a distant site. As of January 1, 2018, distant site practitioners billing telehealth services under the CAH Optional Payment Method II must submit institutional claims using the GT modifier. Bill covered telehealth services to your Medicare Administrative Contractor (MAC). They pay you the appropriate telehealth services amount under the Medicare Physician Fee Schedule (PFS). If you are located in, and you reassigned your billing rights to, a CAH and elected the Optional Payment Method II for outpatients, the CAH bills the telehealth services to the MAC. The payment is 80 percent of the Medicare PFS facility amount for the distant site service.

Hope this helps.

Thanks.

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