Time to Rethink CPT Codes: Reward Early Interventions, Not Just Allow Them
Effective post-discharge care is a cornerstone of value-based healthcare. Yet, current policies fall short of incentivizing the most timely, technology-supported interventions. At Dimer Health, our innovative approach to early follow-up care has demonstrated improved patient outcomes - and it’s also fueling a much-needed conversation about how CPT codes can evolve to reward what truly works.
The Evidence Is Clear: Early, Continuous Follow-Up Works
Our experience consistently shows that engaging patients within 24–48 hours post-discharge, and maintaining continuous, personalized care through face-to-face visits and communication tools, significantly improves outcomes. Research confirms this: early follow-up reduces readmissions, improves medication adherence, and speeds symptom resolution. But when you pair that with AI-powered, continuous care that adapts to clinical data, patient history, and social determinants of health, the results become transformational and patient satisfaction and outcomes soar.
The Status Quo Isn’t Enough
Under current CPT guidelines, Transition of Care Management (TCM) codes require providers to contact patients within 48 hours and schedule an in-person visit within 7–14 days. While this framework sets a minimum standard, it doesn’t encourage or reward care delivered at the most impactful time - immediately after discharge.
To be fair, CPT code policy often references evidence-based medicine, and studies have shown better outcomes for patients seen within 7 days versus not at all. But those studies often used 7 days as an operational benchmark, not a clinical ideal. When we look closely, there’s nothing magical about that 7-day window. In reality, the sooner a patient is seen, the better.
What’s more, the current CPT structure fails to reflect advances in care delivery, especially those powered by AI. At Dimer Health, we’ve built a dynamic AI-driven platform capable of delivering seamless, scalable post-discharge care - regardless of diagnosis or socioeconomic barriers. The system offers real-time, continuous engagement with patients and clinical teams, improving outcomes in ways that were unimaginable a decade ago.
Our 2024 CPT Application - and the Pushback
In 2024, we submitted a proposal to revise CPT codes to support and incentivize earlier follow-up. Admittedly, we were new to the process. One of the main counterarguments was that existing codes don’t prohibit earlier follow-up, they just don’t explicitly incentivize it.
But that misses the point. If the goal is to improve care, reduce readmissions, and support vulnerable patients during a critical time, simply allowing early follow-up isn’t enough. We must reward it.
What If Healthcare Took a Cue from Education?
At school, a paper turned in on time earns full credit. For each day it’s late, 20% is deducted. That’s a clear, time-based incentive that promotes accountability, exactly the kind of structure value-based healthcare needs.
Shouldn’t healthcare do the same? If earlier follow-up improves recovery and reduces system burden, why not build incentives directly into the reimbursement model?
A Call to Action
To truly promote value-based care, we believe CPT codes must be modernized to reward providers who deliver time-critical interventions. This could include higher reimbursements for visits conducted within 24 hours of discharge, or entirely new codes designed around immediacy and continuity of care.
As Dimer Health continues to grow, our goal is to use our platform to drive meaningful change in how the system supports patients during one of their most vulnerable transitions: from hospital to home. We’re confident that small adjustments in policy can spark innovation, improve access, and lead to better outcomes for all.
We invite you to join us in advocating for this shift. Help us bring this conversation to the right stakeholders and push for a care model that rewards what truly works: timely, continuous, patient-centered intervention.
