Transitional Care Management
A 30-day bundled service for the first outpatient contact and follow-up visit after a patient is discharged from an inpatient or institutional setting back to the community.
What it is
Transitional Care Management (TCM) covers the transition of a patient from an inpatient hospital, inpatient psychiatric, long-term care hospital, skilled nursing facility, or outpatient observation/partial hospitalization stay back to a community setting, such as home, domiciliary care, rest home, or assisted living.
The service bundles an interactive check-in shortly after discharge, medication reconciliation, and a required face-to-face visit into a single 30-day code, rather than billing each piece separately.
Who qualifies
- Patient was discharged from an inpatient acute care hospital, inpatient psychiatric facility, long-term care hospital, skilled nursing facility, or outpatient observation/partial hospitalization, to a community setting
- Only one practitioner may report TCM for a given patient during the 30 days following discharge
- Patient has moderate or high complexity medical decision making related to the transition
Codes at a glance
| Code | What it covers | Threshold | Approx. payment | Details link |
|---|---|---|---|---|
| 99495 | Moderate complexity: face-to-face visit within 14 calendar days of discharge | One 30-day service per discharge | ~$220 | Details → |
| 99496 | High complexity: face-to-face visit within 7 calendar days of discharge | One 30-day service per discharge | ~$299 | Details → |
Approximate CY2026 Medicare Physician Fee Schedule national non-facility payment benchmark for non-QP clinicians, before geographic, sequestration, and claim-specific adjustments. Actual reimbursement varies by locality, practitioner status, payer, and billing circumstances. Verify the applicable amount with CMS or your Medicare Administrative Contractor.
What's required to bill
- Interactive contact with the patient or caregiver (phone, email, or in person) within 2 business days of discharge
- At least two separate, documented contact attempts within that 2-business-day window count toward the requirement even if the patient isn't reached, as long as attempts continue until contact is made
- Medication reconciliation and management no later than the face-to-face visit
- A single, required face-to-face visit within 7 days (high complexity) or 14 days (moderate complexity) of discharge: billed as part of TCM, not separately as an E/M visit
- Non-face-to-face services during the 30-day period, such as coordinating care with other clinicians and community resources
Documentation checklist
- Date of discharge and discharging facility/setting
- Date and method of the initial interactive contact, including any unsuccessful attempts
- Medication reconciliation notes
- Date of the required face-to-face visit, tied to the complexity level billed
- Care coordination activity performed during the 30-day period
Common billing mistakes
- Billing the face-to-face visit separately as an E/M code in addition to TCM
- Missing the 2-business-day contact window, or not documenting unsuccessful attempts
- More than one practitioner billing TCM for the same discharge
- Billing TCM during a global surgical period when it isn't permitted
- Choosing 99496 without medical decision making that actually supports high complexity
FAQ
Can TCM be billed if the patient is never successfully reached by phone?
CMS allows the service to still be reported if at least two separate contact attempts are made within 2 business days and documented, even if the patient isn't reached, as long as attempts continue until contact is made or the visit occurs.
Can more than one practitioner bill TCM for the same hospital stay?
No. Only one practitioner may report TCM services for a given patient during the 30 days following discharge.
Is the required face-to-face visit billed separately?
No. The face-to-face visit is bundled into the TCM code itself and should not be billed again as a separate evaluation and management visit.
Can TCM be billed concurrently with Chronic Care Management (CCM)?
Yes, when medically necessary. TCM and CCM can be billed for the same patient in overlapping periods, as long as the same staff time or work isn't counted toward both services, TCM's 30-day transition activities and CCM's monthly care-coordination activities need to be documented separately.