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Pulse Home Health Care practices skilled health care procedures firmly rooted in the latest research and best practice policies. We routinely mail bulletins to physicians and other medical referral sources to highlight how we help patients and to explain the scientific basis for different services. On our home health website we share selected physician bulletins about Pulse's Home Health Services. If you have questions about how home health could help you, please contact us today.

New Billing Opportunities Promise Transitional Care Management
7% Raise for Docs & NPPs

For the 2013 Physician Fee Schedule, the Centers for Medicare & Medicaid Services (CMS) issued final rules that include two new billing codes for transitional care management (TCM).  CMS predicts these codes will result in 7%, 5%, and 4% greater revenues for family practitioners, geriatricians, and internists respectively, but any physician providing the service can bill these new codes.  The fact of the matter is that a handful of doctors will seize the opportunity and increase their revenues much more than 7% while most doctors will not utilize these codes in 2013. These codes pay doctors and non-physician practitioners (NPPs) for coordinating care after discharge from a hospital or skilled nursing facility to the community.  For many practitioners, this will mean being compensated for work they’ve been doing on a largely complimentary basis for years. 

CPT 99495 – Transitional Care Management Services (Moderate Complexity)

  • Communication (including but not limited to email, other electronic, telephone, direct contact, etc.) with the patient or caregiver within two business days of discharge
  • Medical decision making of at least moderate complexity
  • Face-to-face visit within 14 calendar days of discharge

CPT 99496 – Transitional Care Management (High Complexity)

  • Communication with the patient or caregiver within 2 business days of discharge
  • High-complexity medical decision-making
  • Face-to-face visit within 7 calendar days of discharge

These codes will pay $152 or $214 for one office visit plus the non-face-to-face care coordination the doctor chooses to provide for the 29 days after hospital discharge (aka 15 to 21 days after the office visit).  The non-face-to-face work can be performed by the practitioner or by the staff and includes activities such as review of discharge information, communication with Pulse Home Health Care, referrals, patient/family caregiver support, medication management, and accessing community and health resources.  Call Pulse Home Health Care now to have a more detailed billing help sheet delivered to your office.

Keep in mind that your practice is not alone in management of transitional care and that 99495/99496 are not your only billing opportunities.  Additional HCPC codes are billable for certifying the home health plan of care (G0180/G0179) and for home health care plan oversight (G0181) not billed under TCM.  Pulse Home Health Care routinely helps identify and coordinate community resources for your patient (e.g. medical equipment, lab tests, home infusion, personal care, etc.) and intensively provides many of the support services described in the new billing guidelines, but ordering home health does not in any way preclude the practitioner from billing TCM.  Furthermore, Pulse is very much interested in ensuring that your patients visit your practice after discharge as research shows this is very helpful in improving overall quality of care. 


Please tell your patients about Pulse Home Health Care


HomeCare Elite
2009     2010
Named as one of the top 500 agencies nationwide

2325 Severn Ave, Ste 5 Pulse Home Health CareMetairie LA 70001 Pulse Home Health Care(504) 831-7778

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