Medicare AdvantageBilling CodesMedium impact
Best Practices and Coding to Accurately Capture Follow-Up Visits for TRC and FMC HEDIS Measures
Medical Mutual of Ohio·Coding
We identified it
Jun 20, 2026
Summary
Medical Mutual has issued updated coding guidance for Medicare Advantage patients requiring follow-up visits after hospitalizations and ED visits. The policy specifies exact CPT codes to use for documenting transitional care management, medication reconciliation, and outpatient follow-up visits to meet HEDIS quality measures.
Action Required
Immediately: Billing team must ensure proper use of specified CPT codes for Medicare Advantage follow-up visits. Use CPT 99495-99496 for transitional care management, CPT 99483 or 1111F for medication reconciliation, and standard E/M codes (99202-99215, etc.) for outpatient follow-ups. Update encounter forms to include these code options for post-discharge and post-ED visits. Ensure documentation includes all required elements for TRC measures including notification of admission, discharge information receipt, patient engagement, and medication reconciliation within specified timeframes.