Improving Care for Patients Transitioning from Hospital Acute Care to Home

Rosha L. Hamilton, DNP, MSW, BSN; Judith A. Walloch, EdD, RN; Karen Lauer, BSN, RN, MSOLQ; Thomas W. Zoch, MD, FACEP, FACP, CPE


Nurs Econ. 2021;39(2):59-66. 

In This Article

TCM Billing Codes

Transitional care management (TCM) service codes are current procedural terminology codes designed by the Centers for Medicare & Medicaid Services (CMS) to ensure primary care providers follow up with their patients in a standardized manner after discharge from an acute hospitalization or other inpatient settings. When primary care providers (PCPs) use TCM reimbursement billing codes, additional revenue is greater than the reimbursement for an average 30-day hospital follow-up. CMS TCM billing codes involve four major components. To be reimbursed, all four components must be in place. The patient must have a documented non-face-to-face contact within 48 hours post-discharge, a PCP visit within 7–14 days with medical decision-making, specific assessment and documentation including medication reconciliation, and the PCP must submit appropriate billing codes. If all these components are not present, the billing code cannot be used (The Medicare Learning Network, 2019).