CMS and Transitional Care Management Reimbursement Expansion

January 20, 2014
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There is a new expansion to CMS’s new reimbursement for transitional care services to include health professional shortage areas (HPSA) located in rural census tracts of metropolitan statistical areas, which makes it more consistent with other telehealth reimbursement regulations. 

There is a new expansion to CMS’s new reimbursement for transitional care services to include health professional shortage areas (HPSA) located in rural census tracts of metropolitan statistical areas, which makes it more consistent with other telehealth reimbursement regulations. 

However, early last year I posted on this program and highlighted the non-face-to-face aspect, because I see a role for social tools. I’m pleased to see that “electronic” communications continues to be highlighted because it is indicitiative of the regulations being written in a way to be accommodating emerging technologies.

For those of you needing the specific language for the services added to the list of Medicare telehealth services for CY 2014, it is: 

• 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.
This policy will allow the required face-to-face visit component of both services to be furnished through telehealth.