Originally published September 26, 2017. Since 2020 CMS allows TCM to be billed in the same period as CCM and certain other care management services. Payer rules change; confirm current CMS and payer requirements before billing.
Transitional care management (TCM) aims to improve care quality and reduce hospital readmissions after discharge.
- 99495
- TCM with moderate-complexity medical decision-making, face-to-face visit within 14 days of discharge
- 99496
- TCM with high-complexity medical decision-making, face-to-face visit within 7 days of discharge
The 30-day TCM period starts on the day the patient is discharged from the inpatient setting and continues for the next 29 days.
Which date of service to use
Report the date of the required face-to-face visit. You can submit the claim once that visit is done; you don't need to wait until the end of the 30-day period.
Which place of service to use
Use the place of service where the required face-to-face visit took place.
Can E/M be billed with TCM?
Yes. Reasonable and necessary E/M services, other than the required face-to-face visit, provided to manage the patient's clinical issues can be billed separately alongside TCM.
CMS resources: TCM fact sheet and TCM billing FAQ.