Transitional Care Management (TCM)
CPT Codes
A comprehensive guide to TCM CPT codes, billing requirements, service components, and workflows for care continuity after discharge from acute or post-acute settings.
Effective: Jan 1, 2026
CMS PFS (reference)
Rates shown are approximate
What Is Transitional Care Management?
Transitional Care Management (TCM) refers to structured clinical services provided to patients during the 30-day period following discharge from a hospital or similar facility. The purpose of TCM is to reduce readmissions, improve outcomes, and facilitate a seamless shift from inpatient care to community or home-based care.
Key goals include:
- Timely outreach to patients after discharge
- Coordination of care with other providers
- Patient/caregiver education and support
- Medication review and reconciliation
- Early in-person or virtual follow-up
TCM is reimbursed under Medicare Part B and recognized by most commercial payers that follow CPT code standards. Eligible providers include physicians and several types of non-physician practitioners (NPs, PAs, CNSs, CNMs), depending on state scope of practice.
TCM CPT Codes & Requirements
Reference table with all TCM codes, face-to-face visit windows, and minimum requirements. Both codes include coordination tasks and medication reconciliation.
TCM CPT Codes (2026)
Only one TCM code billed per patient in the 30-day period following discharge
| Code | Description | Threshold |
|---|---|---|
99495 | Moderate clinical complexity TCM | Within 14 days face-to-face visit after discharge |
99496 | High clinical complexity TCM | Within 7 days face-to-face visit after discharge |
Important Notes:
- • Both codes require contact with patient within 2 business days of discharge
- • Both codes include coordination tasks and medication reconciliation
- • Only one TCM code is billed per patient in the 30-day period following a qualifying discharge
Core Components of TCM Services
To bill for either 99495 or 99496, documentation and workflows must consistently address these elements:
Appropriate Discharge Sources
TCM applies when a patient is discharged from:
- Acute care hospital
- Skilled nursing facility (SNF)
- Inpatient rehabilitation facility
- Inpatient psychiatric unit
- Long-term care hospital
- Observation status or similar settings
Early Contact Post-Discharge
2 Business Days Contact Requirement
There must be direct contact (via phone, electronic message, or in-person) with the patient or caregiver within 2 business days of discharge.
This contact may be made by the provider or supervised clinical staff, but the supervising provider must document involvement.
Medical Decision Making & Complexity
99495 - Moderate Complexity
Requires moderate complexity medical decision-making. The clinician must address clinical issues that exceed straightforward medical decisions.
Face-to-face visit:
Within 14 days of discharge
99496 - High Complexity
Requires high complexity medical decision-making. Conditions or patient needs are more intricate, involving multiple data points, diagnoses, or significant risk components.
Face-to-face visit:
Within 7 days of discharge
Medical decision-making levels are defined in the AMA CPT and E/M guidelines.
Face-to-Face Follow-Up
A face-to-face visit with the patient must occur within the appropriate timeframe:
99496
Within 7 days of discharge
99495
Within 14 days of discharge
This visit can be in-person or via telehealth, where permitted. It must be separate from the discharge visit itself and clearly documented.
Care Plan & Coordination Tasks
During the 30-day TCM period, services often include:
- Medication reconciliation and management (at or before the face-to-face visit)
- Arranging home services or referrals
- Coordination with community care providers or specialists
- Reviewing discharge instructions and summary
- Education for patients and caregivers
Clinical staff can handle many coordination tasks under general supervision, but the billing provider is responsible for oversight and must document supervision and care decisions.
Billing & Compliance
Billing Frequency
- You may bill one TCM claim per patient per 30-day period after discharge
- If a patient is readmitted during the 30-day period, criteria must still be met before billing (e.g., face-to-face encounter)
Provider Eligibility
TCM services may be billed by:
- Physicians
- Nurse Practitioners
- Physician Assistants
- Clinical Nurse Specialists
- Certified Nurse Midwives
Non-physician practitioners must be <strong>authorized by state law</strong> to perform the services billed.
Documentation Essentials
Good clinical documentation should include:
- Date of hospital discharge
- Date and details of the face-to-face visit
- Complexity level justification (moderate vs. high)
- Date and method of initial contact (within 2 business days)
- Evidence of care coordination (e.g., medication review)
Workflow Example
-
1 Discharge eventTriggers TCM eligibility
-
2 Initial contactWithin 2 business days, the care team contacts the patient or caregiver
-
3 Complexity evaluationProvider evaluates clinical complexity and chooses the appropriate CPT code (99495 or 99496)
-
4 Face-to-face visitScheduled and documented within the required window (7 days for 99496, 14 days for 99495)
-
5 Documentation & billingAll coordination tasks are documented and gathered for billing compliance
Transitional Care Management is an evidence-based approach to optimize patient outcomes after discharge. The two principal CPT codes – 99495 and 99496 – reflect different levels of medical complexity and required timing of follow-up visits while ensuring care continuity. Correct use of these codes supports compliance, enhances revenue capture, and encourages better clinical outcomes during care transitions.
- 30-day post-discharge care coordination
- Two complexity levels: moderate (99495) and high (99496)
- Face-to-face visit required within 7-14 days