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CPT® Code 99241 - New or Established Patient Office or Other Outpatient Consultation Services - Codify by AAPC.
CPT 99496 allows for the reimbursement of TCM services for patients in need of \u201cmedical decision making of high complexity.\u201d Communication between the patient and practitioner must begin within 2 business days of discharge; eligible methods are listed as \u201cdirect contact, telephone [and] electronic\u201d methods.
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 ...
Follow-up visits, like initial visits, should be coded using the appropriate evaluation and management (E/M) code (i.e., 99211\u201399215). Given the limited interaction with the patient and limited work involved, the level of service is likely to be low (e.g., 99211 or 99212).
The codes must be billed using the seventh or 14th day as the date of service and only one healthcare professional may report this service. If more than one physician assumes care and a claim is denied, the provider can bill the visit using an code. The TCM service may be reported once during the entire 30-day period.
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Code 99496 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 high complexity and a face-to-face visit within seven days of discharge. The work RVU is 3.05.
CPT code 99495 \u2013 moderate medical complexity requiring a face-to-face visit within 14 days of discharge. CPT code 99496 \u2013 high medical complexity requiring a face-to-face visit within seven days of discharge.
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.
TCM is billed with CPT code 99495 or 99496, either alone or with other payable services. If it is the only service rendered by a FQHC practitioner, it is paid as a stand-alone billable service. If it is furnished on the same day as another Medicare PPS G code eligible service, only one service is paid.
TCM services can be billed as a visit if it is the only medical service provided on that day with a RHC or FQHC practitioner and it meets the TCM billing requirements. If TCM is furnished on the same day as another visit, only one visit can be billed.

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