Description
A physician or other qualified health care professional who reports Transitional Care Management CPT code 99495 or 99496 may not report telephone services (CPT code 99441-99443) during the time period covered by the transitional care management service codes.
Affected Code(s)
99441, 99442, 99443
Applicable Policy References
1. Social Security Act (SSA), Title XVIII- Health Insurance for the Aged and Disabled, Section 1862(a)(1)(A)- Exclusions from Coverage and Medicare as a Secondary Payer
2. Social Security Act (SSA), Title XVIII- Health Insurance for the Aged and Disabled, Section 1833(e)- Payment of Benefits
3. 42 CFR §405.929- Post-Payment Review
4. 42 CFR §405.930- Failure to Respond to Additional Documentation Request
5. 42 CFR §405.980- Reopening of Initial Determinations, Redeterminations, Reconsiderations, Decisions, and Reviews, (b)- Timeframes and Requirements for Reopening Initial Determinations and Redeterminations Initiated by a Contractor; and (c)- Timeframes and Requirements for Reopening Initial Determinations and Redeterminations Requested by a Party
6. 42 CFR §405.986- Good Cause for Reopening
7. Medicare Claims Processing Manual, Chapter 12 - §30.A – Correct Coding Policy, Coding Based on Standards of Medical/Surgical Practice
8. Medicare Program Integrity Manual, Chapter 3- Verifying Potential Errors and Taking Corrective Actions, §§3.1- 3.6.6
9. Federal Register / Vol. 77, No. 222 / Friday, November 16, 2012 / Rules and Regulations, PFS proposed rule (76 FR 42917 through 42920) https://www.federalregister.gov/d/2012-26900/p-1176
10. AMA CPT Codebook