CMS Pub. 100-02, ch. 13, § 230.1

Effective January 1, 2013, RHCs and FQHCs are paid for TCM services furnished by

an RHC or FQHC practitioner when all TCM requirements are met. TCM services

must be furnished within 30 days of the date of the patient’s discharge from a hospital

(including

outpatient observation or partial hospitalization), SNF, or community mental

health center.

Communication (direct contact, telephone, or electronic) with the patient or caregiver

must commence within 2 business days of discharge, and a face-to-face visit must

occur within 14 days of discharge for moderate complexity decision making (CPT

code 99495), or within 7 days of discharge for high complexity decision making (CPT

code 99496).

The TCM visit is billed on the day that the TCM visit takes place, and only one TCM

visit may be paid per beneficiary for services furnished during that 30 day post-discharge period.

TCM services are billed by adding CPT code 99495 or CPT code 99496 to an RHC

or FQHC claim, either alone or with other payable services. If it is the only medical

service provided on that day with an RHC or FQHC practitioner it is paid as a stand-alone billable visit. If it is furnished on the same day as another visit, only one visit is

paid.