Is CPT 99495 covered by Medicare?

Effective January 1, 2013, under the Physician Fee Schedule (PFS) Medicare pays for two CPT codes (99495 and 99496) that are used to report physician or qualifying nonphysician practitioner care management services for a patient following a discharge from a hospital, SNF, or CMHC stay, outpatient observation, or …

Does CPT code 99495 need a modifier?

Per CCI the 99495 or 99496 cannot have a modifier 25 appended, which may be a hint that it is intended to be billed alone. But a 99396 for example can take a modifier 25. So the combination 99396-25 and 99495 may well be acceptable.

How often can CPT 99495 be billed?

Documentation includes the timing of the initial post discharge communication with the patient or caregivers, date of the face-to-face visit, and the complexity of medical decision-making. Only one individual may report these services and only once per patient within 30 days of discharge.

How Much Does Medicare pay for 99495?

Based on these relative value units (RVUs) and the current (2017) conversion factor, the Medicare allowance for code 99495 performed in a non-facility setting (e.g., a physician’s office) would be approximately $165.45. In a facility setting, the corresponding allowance is approximately $112.

Who can bill for 99495?

CPT Code 99495 covers communication with the patient or caregiver within two business days of discharge. This can be done by phone, e-mail, or in person. It involves medical decision making of at least moderate complexity and a face-to-face visit within 14 days of discharge. The location of the visit is not specified.

How do I bill a TCM?

TCM Coding The two CPT codes used to report TCM services are: CPT code 99495 – moderate medical complexity requiring a face-to-face visit within 14 days of discharge. CPT code 99496 – high medical complexity requiring a face-to-face visit within seven days of discharge.

How Much Does Medicare pay for TCM?

Medicare Part B covers transitional care management (TCM) for 30 days when you are returning to your home or community from a stay in a facility. After you meet your Part B deductible, you will pay a 20 percent coinsurance of the Medicare-approved cost of the service.

How do I bill for TCM?

What does CPT code 99495 mean?

CPT Code 99495 covers communication with the patient or caregiver within two business days of discharge. This can be done by phone, e-mail, or in person. It involves medical decision making of at least moderate complexity and a face-to-face visit within 14 days of discharge.

When can TCM be billed?

30th day
When do I bill for TCM? You should submit your bill on the 30th day post-discharge. TCM covers 30 days of management services with one evaluation service bundled in to the code. The date of service on the claim would be the 30th day post-discharge.