Transitional Care Management (TCM)
White Paper

Transitional care is defined as the coordination between medical providers regarding a particular patient’s medical care as they transition from one healthcare setting or level of care to another. Research has shown that transitional care services helps to reduce adverse patient outcomes, medication errors, recurrence of symptoms, readmission rates, and over-utilization.

The Centers for Medicare and Medicaid Services began covering certain transitional care management (TCM) care beginning in January 2013. Other various commercial insurance payers also cover the TCM codes. Recent billing changes for these TCM services were announced in the 2016 CPT coding guidelines.

A TCM code may only be reported once per patient during the 30 day TCM coverage period and may only be billed by one medical provider. Eligible medical providers include a physician, physician assistant, nurse practitioner, clinical nurse specialist, or certified nurse-midwife who is legally qualified to render services in their state.

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