CMS to Pay Physicians for Services Related to Care Transitions
The 2013 physician fee schedule rate update rule includes a new policy to pay a patient’s physician or practitioner to coordinate the patient’s care in the 30 days following a hospital or skilled nursing facility (SNF) stay. CMS believes recognizing the work of community physicians and practitioners in treating a patient following discharge from a hospital or nursing facility will ensure better continuity of care for these patients and help reduce patient readmissions.
The rule added two new Current Procedural Terminology (CPT) codes - 99495 and 99496 - for transition care management (TCM). These codes allow physicians and non-physician practitioners to bill for non-face-to-face services provided by the physician or practitioner and their clinical staff during the thirty days following discharge from a hospital or SNF.
These services are for a patient whose medical and/or psychosocial problems require moderate or high complexity medical decision making during transitions in care from an inpatient hospital setting - including acute hospital, rehabilitation hospital, long-term acute care hospital, partial hospital, observation status in a hospital, or SNF/nursing facility - to the patient’s community setting consisting of home, domiciliary, rest home, or assisted living facility.