Code Who Payers PDCM Notes Documentation can BCBSM provide service? 99496: MD and DO BCBSM, N All Payers Description: Transitional care management services for patients Transitional of any Description: Transitional care medical and/or psychosocial problems require high complexity medical Medicare Care specialty, management services for patients decision making during transitions in care from an inpatient hospital (including CPC+ Management NP, PA, medical and/or psychosocial setting (including acute hospital, rehabilitation hospital, long-term patients), CNS, or problems require high complexity acute care hospital), partial hospital, observation status in a hospital, or Medicare CNM. Advantage, medical decision making during skilled nursing facility/nursing facility, to the patient’s community Provider Medicaid, transitions in care from an inpatient setting (home, domicile, rest home, or assisted living). does not Priority Health hospital setting (including acute hospital, rehabilitation hospital, long- need to (all Documentation: term acute care hospital), partial have an Managed Date of visit established hospital, observation status in a Medicaid Date of interactive contact with the beneficiary and/or relationship hospital, or skilled nursing Health Plans, caregiver with the facility/nursing facility, to the Traditional Electronic, telephone or face to face patient. patient’s community setting (home, Medicaid Place of service domicile, rest home, or assisted *”Incident Complexity of medical decision making high. Documentation living). to” applies. of any medical or psychosocial problems. Testing ordered, reviewed. Consultations with providers. Indication of Conditions of Payment: number of problems (established or new) The practitioner must Diagnosis: Report the diagnosis(s) for the conditions requiring communicate with the patient by the end of the TCM services. General conditions the patient at the time of day on the second business discharge. day following the day of Medication reconciliation and management no than the discharge. Communication date of the face-to face visit can be face-to-face, phone, or email. CMS-Include documentation fields listed above in "all payer" Face–to-face visit is section, plus the following: required within 7 days of Date of beneficiary discharge discharge Applicable physical exam findings The face-to-face visit is not reported separately, though E&M services provided after the first to-face visit can be billed
Code Who can provide service? Payers PDCM BCBSM Notes Documentation 99496: Transitional Care Management MD and DO of any specialty, NP, PA, CNS, or CNM. Provider does not need to have an established relationship with the patient. BCBSM, Medicare (including CPC+ patients), Medicare Advantage, Medicaid, Priority Health (all Managed Medicaid Health Plans, Traditional Medicaid *”Incident to” applies. N All Payers Description: Transitional care management services for patients medical and/or psychosocial problems require 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, domicile, rest home, or assisted living). Conditions of Payment: The practitioner must communicate with the patient by the end of the day on the second business day following the day of discharge. Communication can be face-to-face, phone, or email. Face–to-face visit is required within 7 days of discharge The face-to-face visit is not reported separately, though E&M services provided after the first to-face visit can be billed Description: Transitional care management services for patients medical and/or psychosocial problems require 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, domicile, rest home, or assisted living). Documentation: Date of visit Date of interactive contact with the beneficiary and/or caregiver Electronic, telephone or face to face Place of service Complexity of medical decision making high. Documentation of any medical or psychosocial problems. Testing ordered, reviewed. Consultations with providers. Indication of number of problems (established or new) Diagnosis: Report the diagnosis(s) for the conditions requiring TCM services. General conditions the patient at the time of discharge. Medication reconciliation and management no than the date of the face-to face visit CMS-Include documentation fields listed above in "all payer" section, plus the following: Date of beneficiary discharge Applicable physical exam findings