CPT 99495: Transitional Care Management, Moderate Complexity
99495 reports transitional care management after a qualifying discharge: contact within 2 business days, at least moderate decision making and a face-to-face visit within 14 calendar days. The 30 day service period begins on the day of discharge.
Written by Salman Saeed, CEO and Co-Founder · Reviewed by a Certified Medical Coder · Last reviewed October 2026In short: 99495 depends on three dates in the chart: the discharge, the first contact within 2 business days, and the visit within 14 calendar days. Only one practitioner can bill TCM for a discharge, and not inside a global surgery period.
What Does CPT 99495 Report?
99495 is transitional care management (TCM) with at least moderate decision making and a face-to-face visit within 14 calendar days of discharge. MLN908628 describes it as the code for a 30 day period that starts on the discharge date and runs the next 29 days. The CMS fee schedule file labels it "Transj care mgmt mod f2f 14d".
| Item | Value in the file |
|---|---|
| Payment status | A (active code) |
| Work RVU | 2.78 |
| Non-facility total RVU | 6.59 |
| Facility total RVU | 3.66 |
| Global period | XXX |
| MUE | 1 per date of service, adjudication indicator 2 (policy) |
The sibling 99496 needs high decision making and a visit within 7 calendar days. Both codes need contact with the patient or caregiver within 2 business days of discharge.
Which Discharges Start a TCM Period?
The period begins when the patient is discharged from one of these settings and returns to a community setting.
What Has to Happen, and by When?
A patient goes home on Thursday, November 5, 2026. The 2 business day contact is due by Monday, November 9. The 14 day visit window for 99495 closes Thursday, November 19, while a 99496 visit would be due by Thursday, November 12. The 30 day period runs through Friday, December 4.
What Limits When 99495 Can Be Billed?
- Only one physician or non-physician practitioner may report TCM, and only once per patient during the period.
- The same professional may discharge the patient, bill hospital discharge day management and bill TCM, but the required visit cannot be on the same day as the discharge day management service.
- The visit is part of TCM and is not reported separately. Other medically necessary E/M visits are billed separately.
- TCM is not paid if any part of the 30 day period falls inside a global surgery period for a procedure the same practitioner billed.
- Document at least the discharge date, the date of first contact, the visit date and the level of decision making.
Physicians of any specialty, nurse practitioners, physician assistants, certified nurse-midwives and clinical nurse specialists can furnish TCM. CCM can be billed during the same period when time is not counted twice, as the CCM 99490 page covers.
How Does 99495 Appear on the Claim?
On the CMS-1500, Item 24D carries 99495, Item 24G carries 1 unit and Item 24E points to the conditions managed in the period. The CMS list of Medicare telehealth services for 2026 includes 99495 with the action "Maintain", and MLN908628 says 99495 and 99496 can be provided through telehealth.
For the specialty view, see internal medicine billing and home health billing.
What Belongs on the Claim Line for 99495?
Transitional care is one line for a 30-day service. Item 24D carries 99495, Item 24G carries 1 unit, and Item 24E points to a diagnosis from the stay that the follow-up addresses. The date of service in Item 24A is the date of the face-to-face visit.
RVU26D gives 99495 status A and global XXX, and the MUE table limits it to 1 with indicator 2 (policy). No second transition code or visit for the same discharge can sit beside it.
Example: A patient is discharged on 10/01. Staff contact the patient on 10/02, and the face-to-face visit happens on 10/09. The claim lists 99495, pointer A (I50.9), 1 unit, $214.00, dated 10/09. If another practice bills TCM for the same discharge, one claim is denied under CO-151.
Why Is 99495 Denied?
| Code | What X12 says | What usually causes it |
|---|---|---|
| CO-151 | Information does not support this many or this frequency of services | A second practitioner billed TCM for the same discharge |
| CO-97 | The benefit is included in the payment for another service already adjudicated | Billed inside a global surgery period, or with the visit billed separately |
| CO-50 | Not deemed a medical necessity by the payer | Note shows only low decision making |
| CO-16 | Claim lacks information or has a billing error | No discharge date or contact date in the record |
If these denials keep coming back, our denial management team can work them. Compare the monthly care management code 99490 and the office visit 99214.
Related Codes
- Physician Fee Schedule relative value files, RVU26D (October 2026) · CMS
- Medicare NCCI Medically Unlikely Edits, practitioner services table, effective 10-01-2026 · CMS
- Medicare Claims Processing Manual, Chapter 26: Completing and Processing Form CMS-1500 Data Set · CMS
- Claim Adjustment Reason Codes · X12
- Transitional Care Management Services (MLN908628, August 2025) · CMS
- Chronic Care Management Services (MLN909188, June 2025) · CMS
- List of Telehealth Services for Calendar Year 2026 · CMS
- Telehealth FAQ, updated October 2026 · CMS
We check every rule, code and deadline against the official source. See our editorial policy.
Common Questions
Straight answers from the team that does the work.
Ask a billing lead directly. A 20-minute call, Monday to Friday, 9am to 5pm Eastern.
01What is needed to bill transitional care management 99495?
You need a qualifying discharge, contact with the patient or caregiver within 2 business days, at least moderate decision making, and a face-to-face visit within 14 calendar days of discharge. Medication reconciliation must be done on or before the visit date.
02What is the difference between 99495 and 99496?
Both need contact within 2 business days. 99495 requires at least moderate decision making and a visit within 14 calendar days, and 99496 requires high decision making and a visit within 7 calendar days, according to MLN908628. The 7 day code is the shorter window, so a visit on day 10 can only support 99495.
03What if the 2 business day contact fails?
You may still report TCM if you make two or more separate, timely contact attempts, document them and meet the other requirements, including a timely face-to-face visit. Keep trying until you reach the patient, and note each attempt in the record.
04Can I bill 99495 and hospital discharge day management?
Yes, the same professional can discharge the patient, bill discharge day management and bill TCM. The required face-to-face TCM visit cannot happen on the same day as the discharge day management service, so schedule it for a later date. Other medically necessary E/M visits in the period are billed separately.
05Can the TCM visit be done by telehealth?
Yes. MLN908628 says 99495 and 99496 can be provided through telehealth, and 99495 is on the CY 2026 CMS telehealth list. Use POS 02 or POS 10 as the CMS telehealth FAQ directs, depending on where the patient is. The visit still counts as the one required face-to-face visit inside the window.
06Can TCM be billed inside a global surgery period?
No. MLN908628 says Medicare does not pay TCM if any part of the 30 day TCM period falls within a global surgery period for a procedure billed by the same practitioner. Check the global period of any recent procedure first.
TCM Claims Missing a Date?
We check the discharge date, the 2 business day contact and the 14 day visit before the claim goes out.