Billing for Transitional Care Management

Many practitioners struggle to collect payment for Transitional Care Management (TCM) services. However, common claim submission errors cause a large share of TCM claims to go unpaid.

To avoid denials, confirm that your practice furnished the entire 30-day TCM service, that the service began with a qualifying discharge from a facility, and that the claim reports the correct date of service.

In this article, we explain the codes, coding rules, and billing guidelines for transitional care management. We also share 2026 Medicare rates and answer common TCM billing questions.

Procedure Codes for Transitional Care Management

Since January 1, 2013, Medicare has paid for two CPT codes, 99495 and 99496, under the Physician Fee Schedule (PFS). Physicians and qualifying nonphysician practitioners use these codes to report care management services after a patient leaves a hospital, SNF, or CMHC stay, outpatient observation, or partial hospitalization.

• CPT Code 99495 requires communication with the patient or caregiver within two business days of discharge. For example, providers can make this contact by phone, email, or in person. The code also requires medical decision-making of at least moderate complexity and a face-to-face visit within 14 days of discharge. CPT does not specify a visit location. Its work RVU is 2.78.
• CPT Code 99496 requires the same communication within two business days of discharge, by phone, email, or in person. It calls for high-complexity medical decision-making and a face-to-face visit within seven days of discharge. Again, CPT does not specify a visit location. Its work RVU is 3.79.

Transitional Care Management Coding Guidelines

When you report transitional care management services with CPT 99495 and 99496, follow these coding guidelines:

• Complete medication reconciliation and management no later than the face-to-face visit.
• Use the codes after discharge from an inpatient hospital setting (acute hospital, rehabilitation hospital, or long-term acute care hospital), partial hospitalization, observation status in a hospital, or a skilled nursing facility/nursing facility.
• Do not report the codes with G0181 (home health care plan oversight) or G0182 (hospice care plan oversight), because these services duplicate TCM.
• Submit the claim once the face-to-face visit is complete. You do not need to wait until the 30-day period ends.
• Medicare pays for TCM only once per patient in the 30 days after discharge, even if the patient returns to the hospital (see the readmission rules below).
• Only one practitioner can bill TCM per patient, so decide early which physician coordinates care during this period. If you are unsure, contact the other physician’s office to confirm. The discharging physician should tell the patient which clinician will provide and bill the TCM services.
• You can report these codes for both new and established patients. Finally, keep clear records of every contact attempt, the visit date, and your medical decision-making.

Billing Guidelines for Transitional Care Management (TCM)

Date of Service

The 30-day transitional care management period begins on the day of discharge and continues for the next 29 days. Therefore, report the date of the required face-to-face visit as the date of service. You may submit the claim as soon as the visit is complete; you do not need to hold it until the service period ends.

Place of Service

For transitional care management claims, report the place of service that matches where the required face-to-face visit took place. However, Medicare does not pay FQHCs and RHCs separately under the PFS, but the face-to-face visit component of TCM can qualify as a billable visit in an FQHC or RHC. Check each payer’s policy before you submit the claim.

Additionally, physicians or other qualified providers who have a separate fee-for-service practice when not working at the RHC or FQHC may bill the CPT TCM codes, subject to the other existing requirements for billing under the Medicare Physician Fee Schedule (MPFS).

Patient Readmission Within 30 Days

If a patient returns to the hospital, practitioners can still report transitional care management as long as they furnish the services the code describes during the 30-day period, including the time after the second discharge. Alternatively, a practitioner can bill transitional care management for a full 30-day period after the second discharge, as long as no other provider bills TCM for the first discharge.

In addition, CPT guidance states that only one individual may report TCM, and only once per patient within 30 days of discharge. The same individual or group cannot report another TCM for any later discharge within those 30 days.

Billing Other Services During Transitional Care Management

You may report other reasonable and necessary Medicare services during the 30-day period, except services that CPT guidance excludes and HCPCS codes G0181 and G0182.

Since 2020, CMS has allowed practitioners to bill Chronic Care Management (CCM) alongside transitional care management for the same patient. However, you must meet every requirement for each service and cannot count the same time toward both. Track the minutes for each service separately.

The Role of a Central Billing Office (CBO) in Healthcare

Transitional Care Management Reimbursement Rates for 2026

Transitional care management reimbursement depends on the complexity of medical decision making and how quickly the face-to-face visit happens after discharge. Here is how the two codes compare:

CPT Code	Medical Decision Making	Face-to-Face Visit	Work RVU	2026 Medicare National Average*
99495	At least moderate	Within 14 days	2.78	≈ $220
99496	High	Within 7 days	3.79	≈ $298

*Approximate national averages. Actual payment varies by locality (GPCI), place of service (facility vs. non-facility), and payer. Check the CMS Physician Fee Schedule Look-Up Tool for your exact rate. Commercial payer rates may differ.

About Medical Billers and Coders (MBC)

Medical Billers and Coders (MBC) is a leading medical billing company that provides complete revenue cycle management services.

Our billing services include eligibility verification, medical coding, charge entry, payment posting, denial analysis, account receivables (AR) management, and provider credentialing and enrollment.

With our medical billing services, including transitional care management billing, you can increase practice collections while staying compliant with payer guidelines.

To learn more about our billing and coding services, contact us at: info@medicalbillersandcoders.com or call us at: 888-357-3226.

Helpful Resources

• CMS: Transitional Care Management Services (MLN908628) – official Medicare booklet on TCM requirements
• CMS: Billing FAQs for Transitional Care Management – date of service, claim timing, and billing rules
• CMS: Care Management Services – overview of TCM, CCM, and related care management codes
• AAFP: TCM Codes and Toolkit – practical coding and documentation guidance

FAQs on Transitional Care Management Billing