Advancing The Profession of Pharmacy

Transitional Care Management and the Consultant Pharmacist

by | Oct 1, 2018 | Consulting Pharmacist Education



Want to watch a video version of this post?  I’ve got you covered!

What counts as a transition of care?


  • Any time the patient is move from an inpatient setting back to their community setting
    • Inpatient status may include an ED visit, inpatient hospital visit or inpatient mental health facility
    • Community setting may include a patient’s home, assisted living facility or even a long term care facility

Many time a post-discharge Transitional Care Management Service can be integrated into an existing CCM program.

What are the CPT Codes for billing?

99495 ~$164 for non-facility setting ~$135 for facility setting

  • Communication (direct contact, telephone, electronic) with patient/caregiver within 2 business day of d/c
  • Medical decision making of at least moderate complexity during the service provided
  • Face-to-face visit within 14 calendar days of discharge
  • Can be in office, in the home or other location of residence

99496 ~$231 for non-facility setting ~$197

  • Communication within 2 business day of d/c
  • Medical decision make on high complexity during service period
  • Face-to-face visit within 7 calendar days of d/c
  • Can be in office, in home or other location of residence

What services a Consultant Pharmacist could offer to patients undergoing Transitions of Care?

  • Medication reconciliation
  • Communication with patient/caregiver
  • Access to care and services need by the patient/their family
  • Review need for follow-up tests and treatments
  • Assist in scheduling appointments
  • May be used on new or established patients

How can you put a program like this together?

A consultant pharmacist in an off site setting such as a community pharmacy or independent consulting firm could provide the primary touch point for a patient in the 48 hours post discharge.

This consultant would need to be engaged in a financial relationship with the physicians office and generally needs to be under a collaborative practice agreement, though not exclusively necessary.

Lesson 7 in the E-course at the Pharmapreneur Academy is ALL about the CCM and TCM codes for billing for pharmacist services!

If you are interested in building your clinical services…

Join us on our next LIVE webinar, Sunday, October 21st at 8pmCDT

Learn the TOP 3 Mistakes Most Pharmacists Make in Their Careers and how the Pharmapreneur Academy can help you build the Career of Your Dreams!

Register HERE.

About the Author

Blair Thielemier, PharmD, is a business development consultant specializing in pharmacist-led billing models. She has set the industry standard for virtual pharmacy conferences with the Elevate Pharmacy Virtual Summit in 2017. She has consulted with national pharmacy organizations, drug wholesalers, point of sale companies, and Fortune 5 health insurers. She has books and online courses available for individuals looking to leverage their pharmacy knowledge into monetized clinical programs at She speaks internationally about trends in leveraging pharmacists to improve value-based care.


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