PYA has updated its white paper, “Providing and Billing Medicare for Transitional Care Management.” The white paper explains in detail the billing rules for transitional care management (TCM), compiling regulations and related guidance from the Centers for Medicare & Medicaid Services.
In 2013, Medicare began reimbursing physicians and non-physician practitioners for TCM to reduce readmissions and improve outcomes. Despite these potential benefits, TCM remains underutilized, likely due to administrative burden and challenges in integrating care coordination processes.
Referencing CPT codes 99495 and 99496, the updated white paper helps providers understand the TCM rules and regulations in an easy-to-follow question-and-answer format that covers many topics:
- Beneficiary eligibility for TCM services
- In-person and non-face-to-face services
- Claim submission
- Reimbursement rates
- And more
PYA assists organizations with successful care management programs. Our multidisciplinary team includes experienced clinicians, regulatory specialists, data analysts, process improvement professionals, and IT specialists.
