Definition
Transitional Care Management (TCM) is a Medicare-reimbursed service covering the 30 days after a patient is discharged from a hospital or other qualifying facility to the community, and it requires interactive contact with the patient within two business days of discharge.
CMS began paying for TCM in 2013 under two CPT codes. CPT 99495 covers medical decision making of at least moderate complexity with a face-to-face visit within 14 calendar days of discharge; CPT 99496 covers high-complexity medical decision making with a face-to-face visit within 7 calendar days. Both require the interactive contact within two business days, which can be made by phone, electronic communication, or in person, by the practitioner or by clinical staff under their direction. Medication reconciliation must be completed no later than the face-to-face visit.
The service period begins on the day of discharge and runs for the next 29 days, and only one practitioner may report TCM for a patient in that period. CMS guidance allows the service to be reported when two or more separate, timely attempts at the interactive contact are unsuccessful and documented and the other requirements are met, which makes recording each attempt part of the workflow.
The two-business-day contact is the time-critical step, because it depends on reaching the patient quickly after they get home. Patients who are not reached, or whose attempts are not documented, inside the window generally cannot be billed for TCM, and they miss the early check-in that post-discharge follow-up programs are built around.
How Consig handles it
Consig calls the whole discharge cohort promptly, uses branded caller ID and reputation management so calls get answered, and documents every attempt. Whether a given contact satisfies TCM billing requirements remains a determination for the customer's billing and compliance team; see post-discharge follow-up.