Transitional Care Management (TCM) FAQs

What CPT codes are used for Transitional Care Management?

Transitional Care Management services use two primary CPT codes:

• 99495: TCM services with moderate medical decision complexity, requiring face-to-face visit within 14 days of discharge.
• 99496: TCM services with high medical decision complexity, requiring face-to-face visit within 7 days of discharge.

What are the requirements for billing TCM codes?

To bill for TCM services, providers must:

• Make an interactive contact with the patient and/or caregiver within 2 business days of discharge
• Provide a face-to-face visit within 7 days (99496) or 14 days (99495) of discharge
• Provide medication reconciliation and management during the service period
• Review discharge information and provide necessary follow-up care
• Help the patient with community and health resources
• Assist with scheduling follow-up appointments with providers and services

Mahalo's platform automates tracking of these requirements to ensure compliance and maximize reimbursement.

What is the reimbursement rate for TCM services?

For Medicare in 2024, the national average payment rates are approximately:

• 99495: $187-$208
• 99496: $247-$282

Commercial payers typically follow Medicare rates but may vary. Mahalo's platform helps identify the appropriate code based on medical decision complexity and visit timing.