Forum - Questions & Answers

Oct 21st, 2014 - Gregg

Transition of care codes

I billed transition of care code 99495 and the claim was rejected by medicare for N428-"not covered when performed in this place of service". My place of service was 01- office with a type of service 11. Any ideas. Thanks.

Oct 21st, 2014 -

re: Transition of care codes

Per the CPT® PLS(place of service) codes, 01 is for pharmacy, PLC for office is 11. Also per CPT® 99495-99496 TCM (Transitional Care Management Services) these codes are for an established patients whose medical and or psychosocial problems require moderate or high complexity medical decision making during transitions in care from an inpatient hospital setting(including acute hospital, rehabilitaton hospital, long term acute care hospital, etc(please look at descripton in CPT® book, page 36) to the patient's commnity setting(home, domiciliry, rest home or assisted living. they are not to be used for office setting with a type of service 11.



Home About Terms Privacy

innoviHealth® - 62 E 300 North, Spanish Fork, UT 84660 - Phone 801-770-4203 (9-5 Mountain)

Copyright © 2000-2024 innoviHealth Systems®, Inc. - CPT® copyright American Medical Association