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CMS to Pay Physicians for Services Related to Care Transitions

CMS to Pay Physicians for Services Related to Care Transitions March 29, 2013

On March 27, 2013, the National Association for Home Care and Hospice (NAHC) highlighted a policy in the 2013 physician fee schedule.  The 2013 physician fee schedule rate update includes a new policy to pay a patient’s physician or practitioner to coordinate the patient’s care in the 30 days following a hospital or skilled nursing facility (SNF) stay.

The rule added the following CPT codes for transition care management (TCM):

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

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

These services are for a patient whose medical and/or psychosocial problems require moderate or high complexity medical decision making during transitions in care from an inpatient hospital setting – including acute hospital, rehabilitation hospital, long-term acute care hospital, partial hospital, observation status in a hospital, or SNF/nursing facility – to the patient’s community setting consisting of home, domiciliary, rest home, or assisted living facility.

TCM is comprised of one face-to-face visit within the specified time frames, in combination with non-face-to-face services that may be performed by the physician or other qualified health care professional and/or licensed clinical staff under his or her direction.

For non-facility based physicians or practitioners, the payments are $164 or $231, subject to geographic adjustment.  These payment rates are higher than level 5 office visits for either new or established patients.  Physicians that bill these TCM codes cannot bill for care plan oversight, codes G0181 or G0182, for those thirty days, but the payment rates for TCM codes are higher than CPO codes.  Physicians may bill for certification and recertification for Medicare home health services, codes G0180 and G0179, in conjunction with the TCM codes.

To access the article please go to the following link:  http://www.nahc.org/NAHCReport/nr130327_1/.

DISCLAIMER:  This post contains only summary information and highlights; it should be read in conjunction with the full article or document provided as a link.  Any advice or recommendations given is general and specific questions should be directed to professional counsel.

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