99495 vs 99496: TCM Timing and Documentation Checklist
Transitional Care Management combines post-discharge coordination with a qualifying face-to-face visit. Seeing the patient within the deadline alone does not satisfy the full service.
Compare the requirements
99495 requires at least moderate MDM and a visit within 14 calendar days. 99496 requires high MDM and a visit within 7 calendar days. Both require timely interactive contact, generally within 2 business days of discharge.
A discharge checklist
Confirm an eligible discharge and community transition. Record contact attempts and completed communication. Reconcile medications by the face-to-face visit. Document MDM and coordination. CMS has specific instructions for unsuccessful contact attempts.
A day-six visit is not automatically 99496
Moderate decision making does not become high complexity because the appointment occurred sooner. Evaluate 99495 if its complete requirements are met.
Check the service period
TCM covers a 30-day transition period. Only one practitioner reports TCM for that period. Review current rules for overlapping services, readmissions, and claim dates rather than automatically adding an office visit.
Frequently asked questions
Where can I find 99495 wRVUs?
Open the code reference below for the current CMS-based work RVU and payment breakdown. Work RVUs are not dollars.
Is the qualifying visit separately billed?
The face-to-face visit is included in TCM; review CMS guidance for other services.
Related code pages
Sources and next steps
Source links checked 2026-09-23. RVUDoc editorial reference; not an independently certified coding review.
Look up 99495 wRVUs and payment ↗Educational reference, not billing or legal advice. Verify against payer contracts and your compliance team before claim submission. Last updated 2026-09-23.