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TCM services 99495 and 99496

Kathy Posted Wed 01st of May, 2019 07:38:25 AM
I am a NPP in Kansas. I am having a hard time understanding the CMS guidelines regarding TCM services CPT codes 99495 and 99496. If a NPP performs the first face to face visit does this visit have to be done in the presence of the supervising physician and considered "Incident To" billing or can the NPP provide the service in the patient's home without the supervising physician present? Thank you.
SuperCoder Answered Thu 02nd of May, 2019 05:14:09 AM

Thank you for your Question.


As per CMS, The required face-to-face visit must be furnished under a minimum of direct supervision and is subject to applicable State law, scope of practice, and the Medicare Physician Fee Schedule (PFS) “incident to” rules and regulations which means the physician must be present in the office suite and immediately available to furnish assistance and direction throughout the performance of the service; however, the physician does not need to be in the room when the service is performed.


The non-face-to-face services may be provided under general supervision. These services are also subject to applicable State law, scope of practice, and the PFS “incident to” rules and regulations. The practitioner must order services, maintain contact with auxiliary personnel, and retain professional responsibility for the service which means the service is furnished under the physician’s overall direction and control, but the physician’s presence is not required during the performance of the procedure. Under general supervision, the training of the non-physician personnel who actually perform the services and maintain the necessary equipment and supplies, is the physician’s continuing responsibility.


Note: If NPP sees a patient for a new problem, he/she will need to bill under his/her own PIN.  Incident-to guidelines do not allow an NPP to bill incident-to a physician’s services (i.e., under the physician’s PIN) when a new problem is addressed.  This could happen in a situation when the patient was scheduled to be seen for an established problem but brings up a new problem during the course of the visit.  Once a new problem is introduced, the visit would need to be billed under the NPP’s PIN, not the physician’s PIN.


Hope this Helps!

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