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CPT Code 99495 | Transitional Care Management Services

CPT code 99495 is a service for managing the care of patients after they have been discharged from a healthcare facility and helps to coordinate their transition back to their home environment.

What Is CPT Code 99495?

CPT 99495 is a medical code used to describe a service called transitional care management.

This service is provided to patients after they have been discharged from a healthcare facility, such as a hospital or nursing home, and helps to manage their care as they transition back to their home environment.

The service includes communication (via direct contact, telephone, or electronic means) with the patient or caregiver within two business days of discharge and a face-to-face visit within 14 calendar days.

The provider will assess and support the patient, provide education on ongoing care, coordinate care, and ask about medication use.

The service requires the provider to have at least a moderate level of medical decision-making during the service period and serves as the first contact for managing or coordinating services.

Description

The CPT book describes CPT code 99495 as: “Transitional care management services with the following required elements: Communication (direct contact, telephone, electronic) with the patient and/or caregiver within two business days of discharge At least moderate level of medical decision making during the service period Face-to-face visit, within 14 calendar days of discharge.”

Procedure

The provider manages the period of transitional care post–discharge from a healthcare facility, such as an inpatient hospitalization, partial hospitalization, observation, or skilled nursing facility, to the patient’s home, including a private residence, assisted living, rest home, or short–term housing such as a hotel.

The provider communicates with the patient or caregiver within two business days of discharge and provides a face–to–face visit within 14 calendar days of release, addressing areas such as patient assessment and support, education on ongoing care, care coordination, and asking about medication use, among others.

The service requires at least moderate medical decision-making over the service period. The provider serves as the first contact as the individual overseeing management or coordinating services.

How To Use CPT 99495

Report CPT 99495 when the face–to–face visit is within 14 calendar days of discharge, and there is at least moderate–level medical decision-making. 

Report CPT 99496 when the face–to–face visit is within seven days of discharge and there is high–level medical decision-making.

Resources

CPT Professional 2022

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