Billing Transtion of care to BCBS

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Can any one tell me why BCBS is denying transition of care codes ( 99495 -99496 ) . I have been getting paid from other insurance , I cant get BCBS to pay these codes. Can any one help with this. Thank you
 

Rebecca Pate

Networker
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43
Location
Columbus GA
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Bcbs tcm

I am having the same problem. The explanation they give makes no sense. Does anyone have any insight to offer?

Thanks!
 

abyrne

Networker
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Location
De Pere, WI
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Anthem BCBS does not cover TCM codes.
These most likely will need to be billed out as EM codes if appropriate.
 
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TOC is a non-covered service under BCBS. We went through this a year ago & had the same confusion because they had Cpt codes 99495 & 99496 on their fee schedule.
We received clarification from our Provider Rep & TOC is definitely non-covered. You will have to bill these visits following E/M coding guidelines.

Perhaps they will cover TOC in 2017. I know under best practices thre are only a handful of codes that will be payable in 2017 and the rest will fall under capitation. We'll have to wait and see.
 
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