Transitional Care Management Services, High Complexity

CPT code 99486 designates assessment and care coordination for patients requiring moderate or high-complexity medical decision-making of two or more chronic conditions. This code is applied when healthcare providers engage in the assessment and care coordination of patients with two or more chronic conditions, necessitating moderate or high-complexity medical decision-making.

CPT code:

99486

Category:

Category I

Section:

Explore Evaluation and Management CPT Codes

Specialty:

Inpatient Neonatal Intensive Care Services and Pediatric and Neonatal Critical Care Services

Type:

Pediatric Critical Care Patient Transport

In the landscape of care coordination, 99486 holds significance, representing services for patients with two or more chronic conditions. Healthcare providers utilize this code when providing assessment and care coordination that requires moderate or high-complexity medical decision-making. Its use ensures accurate documentation of efforts in the comprehensive management of patients with multiple chronic conditions.

Under what category does Transitional Care Management Services, High Complexity fall?

Category I

What is the billing unit for Transitional Care Management Services, High Complexity?

Per Encounter

Modifiers

Clinical use

Transitional care management services with high medical decision complexity, including face-to-face visit within 7 days of discharge.

Documentation

Transitional care management services, provided within 14 days of discharge, including medical decision-making of high complexity during the service period, face-to-face visits, and communication with the patient and/or caregiver within two business days of discharge. Document the date of discharge, face-to-face visits, medical decision-making complexity, and communication with the patient or caregiver.