Issue Brief: Transitional Care Management (TCM) Services

In a recent VSSL Volumes Issue Brief, VSSL member Dr. Leah Marcotte and UW Internal Medicine resident Dr. Carly Hudelson (a 2019-2020 VSSL Policy and Care Delivery Immersive participant) provide a summary of key points related to Transitional Care Management (TCM) services. In the era of value-based payment and care, TCM has become increasingly important as a potential strategy for provider organizations seeking to better coordinate care for patients discharging from acute hospital stays. The TCM brief by Drs. Hudelson and Marcotte is the first installment of a series of VSSL Volumes briefs about services and policies aimed at improving care coordination for patients.

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As Drs. Hudelson and Marcotte write, "In 2013, the Centers for Medicare and Medicaid Services (CMS) introduced new Transitional Care Management (TCM) billing codes (99495, 99496) as a way to better compensate outpatient primary care providers (PCPs) and their teams for managing care transitions after patients are discharged from hospitals.1 Early analysis of TCM has been favorable. In the first three years these codes were available, patients who received TCM services had significantly lower mortality, readmissions, and healthcare costs compared to those who did not, although uptake was low. 2 Since the creation of these codes, CMS has worked to remove barriers to use. However, there remains confusion about what specifically is required to bill for TCM services. This issue brief provides guidance for PCPs and other ambulatory care providers interested in incorporating these codes into their practice." Read the TCM brief in full.