TRANSITIONAL, REMOTE, CHRONICCARE&PRINCIPAL CARE

- Time included in a CCM service cannot be counted towards other billed time-based codes

- Transitional Care Codes 99495 (TCM? within 14 calendar days of discharge) or 99496 (TCM? within 7 days of discharge) may be reported by the same practitioner during the 30-day TCM service period as Chronic Care Management codes 99487 (CCM? multiple? first 60 minutes of clinical staff time directed by a physician or other qualified healthcare professional), 99489 (CCM? multiple? first 30 minutes of clinical staff time directed by a physician or other qualified healthcare professional) or 99490 (CCM? multiple? first 20 minutes of clinical staff time directed by a physician or other qualified healthcare professional)

- RHCs & FQHCs may report general care management once per month using G0511 for 20 minutes or more of clinical staff time devoted to TCM, CCM, PCM, chronic pain management (CPM) or Behavioral Health Integration (BHI) services provided by a qualified healthcare professional

- Consent:

Obtain written consent from the patient for CCM services, explaining the scope and nature of the services, that only one practitioner (per month) may furnish and bill the CCM services The patient should be notified of cost-sharing requirements

TRANSITIONAL, REMOTE, CHRONICCARE&PRINCIPAL CARE

Principal Care Managem ent :

Principal Care Management (PCM) services are designed to furnish care to CCM patients who may have one or more chronic conditions with a focus on improving a single high-risk condition. PCM services involve the coordination and management of a patient's healthcare needs across multiple providers, ensuring continuity and seamless transitions between different care settings

KeyComponentsof PCM:

- Care Coordination:

PCM services involve coordinating and integrating healthcare services across different providers and settings. This includes facilitating communication between healthcare professionals, scheduling appointments, arranging necessary tests or procedures, and ensuring the timely exchange of medical information Effective care coordination enhances patient safety, reduces duplicative tests or treatments, and promotes the delivery of appropriate and timely care