Forum - Questions & Answers

Jan 26th, 2016 - mnpowell

Updated TCM DOS

I recently listened to an audio presented by Betsy Nicoletti in which she said that as of 1/1/16, the correct DOS to use for 99495 or 99496 is the DOS in which the face to face visit was performed. In the past we have used the 30th day following the discharge. Does anyone have information supporting this new change? Thanks in advance.

Feb 2nd, 2016 - Codapedia Editor 1,399 

re: Updated TCM DOS

CMS enacted this change in their Final Rule, effective Jan 1, 2016.

Feb 4th, 2016 - jberg02 1 

re: Updated TCM DOS

Do you have the website that has this information.

Feb 10th, 2016 - Codapedia Editor 1,399 

re: Updated TCM DOS

Here's what you can do:

Download the CMS Final Rule. Here's how you can search for it:

DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services
42 CFR Parts 405, 410, 411, 414, 425, and 495 [CMS-1631-FC]
RIN 0938-AS40
Medicare Program; Revisions to Payment Policies under the Physician Fee Schedule and Other Revisions to Part B for CY 2016

On pages 131/132 you'll see this:

Response: We will take these comments into consideration in the development of potential proposals for future PFS rulemaking. We will develop subregulatory guidance clarifying the intersection of fax transmission and CEHRT for purposes of CCM billing. Regarding TCM services, we are adopting the commenters’ suggestions that the required date of service reported on the claim be the date of the face-to-face visit, and to allow (but not require) submission of the claim when the face-to-face visit is completed, consistent with current policy governing the
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CMS-1631-FC 132
reporting of global surgery and other bundles of services under the PFS. We will revise the existing subregulatory guidance for TCM services accordingly.



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