Nuts and Bolts Information

Links for billing guidelines and reimbursement 

• Got Transition Coding and Payment Tip Sheet 2025
• Children’s Health of Orange County (CHOC) published their initial experience opening a multi-specialty transition clinic, included some billing and coding information: “Developing a specialty transition clinic: Inaugural clinical and financial operations” 
• Prestidge C et al. Utility and cost of a renal transplant transition clinic. Pediatr Nephrol. 2012 Feb;27(2):295-302. doi: 10.1007/s00467-011-1980-0. This paper described the potential financial benefit of a transition clinic in renal transplant. 

How to fit transition appointments into an existing clinic structure – and bill!

Multiple providers in the same group are unable to bill separately on the same day for the same patient per CMS. Suggested options may include scheduling visits on a separate day and using the appropriate codes, or to  incorporate transition assessment and education into the same visit, using the appropriate codes.

See 2023 Transition Coding and Payment Tip Sheet for billing case scenarios based on patient visits.

Transplant Systems

Getting Administration buy-in for transition resources and staffing

Provider stakeholders must recognize that  market trends and reimbursement models lead to the fiscal sustainability of a program and should work with the financial department to better understand value-based care versus capitation payment systems.  

• Transition leaders should have  a clear vision of transition program goals and development to rally others in supporting the cause.  A structured system of working groups should be organized to define the program philosophy, goals, organization, and tasks. National standards of care benchmarks in healthcare transition should be used in developing program structure and guidelines.
• Transition leadership should strategically develop a formalized business plan that includes key resources, with a delineation of needs and rationale, so that the systems stakeholders have an understand of the utility and productivity of each provider in achieving the goals of a transition program.
• Buy-in can be achieved through forming collaborative relationships and building credibility regarding the utility of healthcare transition.      Schedule meetings to engage the C-suite executive leadership, marketing team, service line directors, and divisional administrators.  Discuss your program at every opportunity and engage Marketing and the PR team!
• Operationalizing strategic initiatives takes teamwork and stakeholder engagement. By aligning the fundamental mission of healthcare transition with fiscal incentives for Administration, a collaborative partnership to support transition program development will evolve.
• Administration should appreciate that improving quality of care through a comprehensive transition program enhances the patient experience.  Brand presence will also be enhanced by a healthcare system that provides transition services.
• Engage marketing and PR teams in understanding what patients need through national standards of care benchmarks.