Wiki Transitional Care CPT Codes

[chavera]

I need some help clarifying if the transitional care management codes are only for Medicare and Medicare advantage patients?

Thank you!

 

[xlbctso]

Check with your payers. The payer I work for is covering the codes under its Commercial business with caveats (PCMH vs non-PCMH provider).

 

[twsihler]

Tcm

that's correct .. you have to check with individual payers. Most commercial payers I've seen are not recognizing the TCM codes but there are supposedly some out there who do.

 

[REDFIELD]

As with all CPT codes, they may be payer specific as to coverage and reimbursement; of note, CPT indicates these codes (99495, 99496) are for established patients, however, Medicare appears to have waived this exception - at least that's my take. Best practice might be to have your billers contact their individual payers and ask beforehand, spreadsheet those that will consider the codes and charge regular visit codes (99201-99215) for those that do not.

 

[catkinson80]

Tricare does not pay for TCM. Be careful if they are secondary to Medicare. Most BCBS and Aetna plans cover it.