Transitional Care Management (CCM)

Description: Transitional care services during the 30-day period that begin when a patient discharges from an inpatient stay and continues for the next 29 days. The helps individuals transition back to a community after a facility stay.

Delivery Method: TCM services include both face-to-face and non-face to face services (phone/letter) and/or telehealth

Who Can Bill? Physicians, and non-physician practitioners (Physician Assistants, Nurse Practitioners, Clinical Nurse Specialists and Certified Midwives). Clinical staff activities are included under the supervision of the billing practitioner.

Payer	Code	Billing Allowance	Description	Requirements
Medicare	99495	Must provide 1 face-to-face visit within the timeframes described	TCM services include direct communication with patient or caregiver within 2 business days of discharge at least a moderate level of medical decision making during the F2F visit, within 14 calendar days of discharge	The interactive contact must be performed by clinical staff who can address patient status and needs beyond scheduling follow-up care You may report the service if you make 2 or more unsuccessful separate contact attempts in a timely manner Document your attempts in the patient’s medical record Continue trying to contact the patient until you’re successful If the face-to-face visit isn’t within the required timeframe, you can’t bill TCM services Medication reconciliation and management on or before the face-to-face visit date.
Medicare	99496		TCM services include direct communication with patient or caregiver within 2 business days of discharge at least a high-level of medical decision making during the F2F visit, within 7 calendar days of discharge

*For additional details regarding requirements please reference CMS guidelines*

MICMT does not have expertise related to the Centers for Medicare and Medicaid services coverage decisions related to billing. The information contained on this site comes from publicly available sources of CMS information. Any needed clarification should come from CMS or their representatives/contractors.

Reference Materials