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Medicare OKs care coordination codes


Medicare will pay primary care physicians for care coordination.

Medicare will pay primary care physicians for care coordination.

In fact, according to an advisory by the American Medical Association (AMA), Medicare is accepting Current Procedural Terminology (CPT) codes to reimburse for management of patients recently discharged from a hospital or skilled nursing facility.

“The American Medical Association CPT Editorial Panel created new codes (99495 and 99496) with broad input from the healthcare community to capture transitional care management services,” the AMA reports.

“The codes allow for efficient reporting of time spent discussing a care plan, connecting patients to community services, transitioning them from inpatient settings, and preventing readmissions.”

The latest move from the Centers for Medicare and Medicaid Services (CMS) has been at least a year in the making as a way to cover related services to support physicians participating in emerging models of care, such as Patient-Centered Medical Homes, accountable care organizations (ACOs), and other novel integrated delivery systems, the association reports.

“Medicare’s acceptance of the new codes signals that CMS recognizes the important role these services have in improving the overall quality of healthcare,” adds AMA President-elect Ardis Dee Hoven, MD. “The decision supports the work involved in transitioning patients from one care setting to the next and physicians working in emerging models of care.”

The AMA/Specialty Society Relative Value Scale Update Committee also played “an essential role” in providing Medicare with recommendations on the value of services reported by the new transitional care codes, the AMA says. 


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