Transitional care management (TCM) codes, introduced in CPT® 2013, allow providers to receive reimbursement for their efforts and the efforts of their staff to promote successful outcomes for patients transitioning from a facility setting (e.g., inpatient hospital, nursing facility) to a community setting (e.g., home, assisted living facility).
When you compare TCM payment rates to the new and established patient E/M codes, you will see they are significantly higher (The CMS national payment amount for 99495—TCM of moderate complexity —is $163.99, and for 99496—high complexity TCM—is $231.36.). The additional reimbursement compensates for non-face-to-face activities (e.g., communication with home health agencies) performed by the provider and/or clinical staff under the direction of the provider.If you are new to TCM you can read our blog post: The Beginners Guide to Transitional Care Management
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TCM enables enhancing your provider's reputation. In the Oculus care coordination model, patients take an active role in their care. They understand their care plan and feel comfortable reaching out to their care team.
Engaging diverse patient communities and their families and caregivers in a more active and empowered way will require a significant shift in thinking and patient engagement strategies for many providers, especially as care teams seek to serve a high volume of patients at lower cost.