Transitional Codes

The National Association of Rural Health Clinics (NARHC) after some discussion with the Centers for Medicare & Medicaid Services (CMS) has been informed that RHCs will be able to bill for the new care transition/coordination codes. Originally, there was some concern that this would not be the case because the proposed policy did not mandate physician/PA/NP involvement. However, in the final rule, CMS included a face-to-face encounter with one of the above providers for a medically necessary service therefore making the service a billable RHC encounter.

The two new codes are below along with the elements that will be necessary to bill for either of these codes. These will be billable as RHC encounters and the clinic will receive the RHC payment rate for these services.

99495 – Transitional Care Management Services with the following required elements: Communication (direct contact, telephone, electronic) with the patient and /or caregiver within 2 business days of discharge. Medical decision making of at least moderate complexity during the service period. Face-to-face visit, within 14 calendar days of discharge.

99496 – Transitional Care Management Services with the following required elements: Communication (direct contact, telephone, electronic) with eth patient and/or caregiver within 2 business days of discharge. Medical decision making of high complexity during the service period. Face-to-face visit, within 7 calendar days of discharge.

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