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August 2015

Clarification: transitional care management

In the May and August 2014 editions of The Record, we reported that procedure code 99495 is not payable for Blue Cross Blue Shield of Michigan contracts. The Federal Employees Program® is the only exception.

Procedure code 99496 remains payable for all cases of transitional care management.

The provider must communicate directly, electronically or by telephone with the patient or caregiver within two days of discharge from an inpatient hospital, skilled nursing facility or community mental health center stay, outpatient observation or partial hospitalization. A face-to-face visit must occur within seven business days of the patient’s discharge.

Services performed during the face-to-face visit must take place in conjunction with the appropriate non-face-to-face TCM services outlined within the “Transitional Care Management Services” section of the CPT manual.

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*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2014 American Medical Association. All rights reserved.
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