Part of Transitional Care Management
CPT 99495: Transitional Care Management, moderate complexity
TCM for a discharge requiring moderate complexity medical decision making, with a face-to-face visit within 14 days.
Time threshold & code combinations
One service per discharge, covering the 30 days following discharge; face-to-face visit must occur within 14 calendar days.
- Mutually exclusive with 99496 for the same discharge: choose based on the visit timing window and complexity actually documented
- Do not separately bill the required face-to-face visit as its own E/M code
Who can bill
- Physicians
- Non-physician practitioners eligible to bill E/M services
Eligibility & billing requirements
- Patient discharged to a community setting from an inpatient or qualifying institutional stay
- Medical decision making of moderate complexity related to the transition
- Interactive contact within 2 business days of discharge
- Medication reconciliation no later than the face-to-face visit
- Face-to-face visit within 14 calendar days of discharge
When to use it
Post-hospitalization follow-up
A patient discharged home after a pneumonia admission is called within 2 business days, has medications reconciled, and is seen face-to-face on day 10.
Billing: 99495
SNF-to-home transition
A patient discharged from a skilled nursing facility to assisted living is contacted the next business day and seen in clinic on day 12 with moderate complexity decision making.
Billing: 99495
Documentation checklist
- Discharge date and setting
- Contact date/method (including unsuccessful attempts, if any)
- Medication reconciliation notes
- Face-to-face visit note dated within 14 days, supporting moderate complexity
Common billing mistakes
- Billing 99495 when the visit actually happened within 7 days and decision making was high complexity (should be 99496)
- No documented 2-business-day contact attempt