Medicare Compliance & Reimbursement

No separate payment for face-to-face visit. While emergency physicians are not specifically prohibited from using transition of care codes by either the Centers for Medicare & Medicaid Services or CPT®, the likelihood of their being able to meet the requirements to report these codes is low. The lowdown: The new codes capture the non-face-to-face time physicians, non-physician practitioners and other clinical staff spend in the 30 days following a patient’s release from a hospital or skilled nursing facility (SNF). Originally labeled a G-code in the proposed fee schedule, TCM services are now CPT® codes 99495-99496. In the final rule CMS states, "In conjunction with adopting the AMA CPT® TCM, we accept the recommendation to allow reporting of emergency department visits by [qualified primary care physicians] when also billing the CPT® TCM codes." CMS anticipates these new codes will be paid for through one percent reductions in Medicare payment to specialties. [...]