Transitional care visits for enhanced patient care

Anthem Blue Cross and Blue Shield Medicaid has adopted a new professional reimbursement policy: Transitional Care Management, effective September 1, 2024. The CPT^® definition for these codes is designed for primary care visits after patient discharge from hospital admission. Anthem has extended that definition to also include discharges from the emergency room. Transitional Care Management is essential to prevent readmissions and additional emergency room episodes. The expanded use of Transitional Care Management is a triple win: for the patient, the primary care physician, and Anthem.

If you have additional questions or need further clarification, please reach out to your Anthem provider relationship management representative or call Provider Services at 855-661-2028.