CPT Code Overview for TCM: Transitional Care Management Billing Essentials

OnCare360

Jun 6, 2025

Transitional Care Management (TCM) services support patients as they transition from an inpatient or skilled nursing facility back to the community. By ensuring follow-up within the first 30 days, TCM improves outcomes, reduces readmissions, and qualifies for Medicare reimbursement. This page provides an authoritative overview of TCM CPT codes, requirements, and documentation essentials.

What Are the CPT Codes for TCM?

TCM is billed using two primary CPT codes:

CPT Code	Description	Time Frame	Notes
99495	Transitional care management services, moderate complexity medical decision making, with a face-to-face visit within 14 days of discharge	Per 30-day episode	Requires non-face-to-face services in addition to visit
99496	Transitional care management services, high complexity medical decision making, with a face-to-face visit within 7 days of discharge	Per 30-day episode	Higher reimbursement than 99495 due to acuity and earlier visit

Who Can Bill TCM Services?

Physicians (MD/DO)
Nurse Practitioners (NP)
Physician Assistants (PA)
Certified Nurse Midwives (CNM)

Clinical staff may furnish many non-face-to-face services incident to the billing provider, under general supervision rules.

TCM Service Components

To bill TCM, the following elements must be met:

Patient Eligibility – Recently discharged from hospital, SNF, or outpatient observation.
Interactive Contact – Direct contact (phone, electronic, or in-person) with the patient/caregiver within 2 business days of discharge.
Face-to-Face Visit
- 99495: within 14 days
- 99496: within 7 days
Medical Decision Making
- 99495: Moderate complexity
- 99496: High complexity
Non-Face-to-Face Services – Medication reconciliation, patient education, care coordination, scheduling services, and reviewing discharge information.

Billing Requirements and Best Practices

Bill once per 30-day transition period, beginning on the date of discharge.
Only one provider may bill TCM during the 30-day period.
Document all attempted and completed outreach attempts (phone logs, electronic messages).
Clearly record date of discharge, date of first contact, and date of face-to-face visit.
Differentiate TCM services from CCM, PCM, or RPM if billed in the same timeframe.

Sample Documentation Language

99495 Example:
“Patient discharged 08/01/2025 from General Hospital following COPD exacerbation. Interactive phone call completed 08/03/2025 (2 business days). Face-to-face office visit on 08/10/2025. Medication reconciliation performed, care plan updated, referrals arranged. MDM: Moderate complexity.”

99496 Example:
“Patient discharged 08/01/2025 after acute CHF admission. Contacted patient on 08/02/2025. Face-to-face visit on 08/05/2025. Reviewed labs, adjusted diuretics, coordinated home health services. MDM: High complexity due to unstable condition and risk of readmission.”

TCM Billing Quick Reference

99495: Moderate MDM, face-to-face within 14 days
99496: High MDM, face-to-face within 7 days
Interactive patient/caregiver contact required within 2 business days of discharge
Non-face-to-face care coordination must be documented
Only one provider may bill during the 30-day transition

Frequently Asked Questions

Can TCM and CCM be billed in the same month?
Sometimes. Both may be billed if criteria are met, but time and activities must be distinct, and not duplicative.
Do specialists or only PCPs bill TCM?
Both may bill, provided they assume care responsibility during the transition and meet requirements.
Does the face-to-face visit need to be in-person?
Yes. CMS requires the TCM face-to-face visit to occur in person, not via telehealth, except under temporary public health emergency flexibilities.
What settings qualify as discharges?
Hospital inpatient, partial hospitalization, skilled nursing facility, and observation status.

Ready to Implement TCM?

OnCare360 supports TCM with structured workflows, discharge tracking, clinical protocols, and compliant billing support.
Contact us today for a tailored strategy session.