Q&A: Reimbursement for transition management services

Q: Are there reimbursement codes for transition services that case managers provide?

A: Care coordination provided by case managers is now part of the National Quality Strategy. As a result, CMS supports reimbursement of case management services in transition management. “Transition” is the time that patients spend between care sites, and it has been identified as the period during which patients are most vulnerable and most at risk for hospital readmissions. CMS has recognized that interventions by case managers following a hospital discharge can ensure that the patient stays on track for a positive recovery. Such interventions help patients understand their discharge instructions and have the resources and tools as ordered (e.g., appropriate medications, transportation to physician/specialist, use of durable medical equipment).

Today, there are reimbursement codes for case management known as Transitional Care Management (TCM) service codes, and there are CPT® codes within the ambulatory settings (99495 and 99496). Additional codes cover non-face-to-face interventions as well.

For more information, see Longitudinal Case Management: Designs Across the Continuum of Care.

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