99495
Transj care mgmt mod f2f 14d
Transitional care management with moderate medical decision making: an interactive contact within 2 business days of discharge, a face-to-face visit within 14 calendar days, and 30 days of post-discharge care management. CMS 2026 wRVU 2.78, paid using the national GPCI and the 2026 conversion factor of $33.4009. One of the highest-value services a primary care practice can bill, and one of the most under-captured.
A patient discharged from the hospital can trigger both chronic care management and transitional care management. Since 2020 Medicare allows both in the same month. Here is how to bill both without a denial, and when to pick one.
Transitional Care Management hinges on a 2-business-day contact and a 7 or 14 day face-to-face. Here is how 99495 and 99496 differ and what documentation each needs.
Billing guidance for 99495 is locked
- When to use it: the exact clinical situations that support billing 99495
- Documentation checklist: the 5 elements your note needs before submitting
- Common pitfalls: the 6 mistakes that get 99495 downcoded or denied
Payer notes
Medicare pays 99495 at roughly the level of a 99204 for what is often a single structured visit plus coordination your staff already does, which is why mature practices treat the hospital discharge feed as a billing pipeline. Medicare Advantage follows Medicare; many commercial payers also reimburse TCM, often at favorable rates. Care plan oversight, home health certification (G0180/G0179), and certain other care management services cannot be billed by the same practitioner during the TCM period; check the bundling list before adding services.