Article Detail - JF Part B

It is important to note what is meant by ‘direct contact’ when submitting CPT codes 99495 and 99496. The term ‘direct contact’ does not include the use of digital assistants such as chat bots, Siri, or Alexa for the required interactive communication.

CPT guidelines state, "TCM is comprised of one face-to-face visit within the specified timeframes, in combination with non-face-to-face services that may be performed by the physician or other qualified health care professional or licensed clinical staff under his or her direction."

For codes 99495 and 99496, ‘direct contact’ is referred to as one of three types of communication with the patient or caregiver within 2 business days of discharge. The other two types of communication would be telephone and electronic. Both codes may be reported through synchronous (real-time) interactive audio-video telemedicine services when appended by modifier 95.

The CPT guidelines provide additional information for interactive contact:

• "TCM requires an interactive contact with the patient or caregiver, as appropriate, within two business days of discharge. The contact may be direct (face-to-face), telephonic, or by electronic means. Medication reconciliation and management must occur no later than the date of the face-to-face visit."
• The required contact with the patient or caregiver, as appropriate, may be by the physician or qualified health care professional or clinical staff. ‘Within two business days’ of discharge is Monday through Friday except holidays without respect to normal practice hours or date of notification of discharge. The contact must include capacity for prompt interactive communication addressing patient status and needs beyond scheduling follow-up care.

The Transitional Care Management Services MLN Booklet corresponds with the CPT guidelines.

See Noridian’s TCM webpage