Triumph for Geriatrics and AGS, CMS Adopts Transitional Care Management Services

November 7th, 2012

In a move long championed by the American Geriatrics Society (AGS) and supported by other leading healthcare organizations, the Centers for Medicare and Medicaid Services (CMS) will begin paying physicians and other qualified healthcare providers for coordinating Medicare beneficiaries’ care transitions during the 30 days following their discharge from hospitals or skilled nursing facilities to their homes or assisted living facilities.

CMS released its CY 2013 Final Physician Fee Schedule on November 1 and AGS is delighted to report that CMS will adopt two CPT codes for “Transitional Care Management (TCM) Services.” Establishment of these codes was spearheaded by AGS, which led the formation of a coalition of 15 other medical specialty societies to develop the codes and associated payment policies.

TCM services are described by CPT codes 99495 and 99496. These codes include all the non-face-to-face services related to the discharge that are performed by clinical staff and the physician (or other qualified health professional) during the 30 days post discharge as well as a single face-to-face visit that occurs after discharge. Payment for these services is intended to help prevent re-hospitalizations and emergency visits during the post-discharge period and is only to be used for moderate or high complexity patients with multiple co-morbidities, who take multiple medications and who are at high risk of deterioration.

This was a two year process and the AGS is proud of its members and staff who have spent the last two years devoting their time and energy toward ensuring that TCM services were accepted by CMS. For a more detailed report of these services, the key players involved, and AGS’s leadership role, please stay tuned for our Q4 newsletter which will be available by mid-December. We are also in the process of developing educational materials, and are summarizing other key elements of the Final Rule to share with you. We will alert members of these updates upon completion.

Modified On: November 8th, 2012