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November 2016

Reminder: Procedure codes for transitional care management

As we wrote in the August 2015 Record, procedure code *99495 is not payable for Blue Cross Blue Shield of Michigan contracts, with the exception of Federal Employee Program® members, and procedure code *99496 is payable for all cases of transitional care management.

The provider must communicate directly with the patient or caregiver by phone, text, fax or email within two days of discharge from:

  • An inpatient hospital
  • A skilled nursing facility
  • A community mental health center
  • An outpatient observation
  • A 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 transitional care management services outlined within the Transitional Care Management Services section of the CPT manual.

No portion of this publication may be copied without the express written permission of Blue Cross Blue Shield of Michigan, except that BCBSM participating health care providers may make copies for their personal use. In no event may any portion of this publication be copied or reprinted and used for commercial purposes by any party other than BCBSM.

*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2015 American Medical Association. All rights reserved.
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