Transitional care is one of the most critical phases in a patient’s health journey—especially after discharge from a hospital, skilled nursing facility, or rehabilitation center. For medical practices and healthcare organizations, effectively managing this period not only improves patient outcomes but also boosts operational efficiency and revenue. This is where transitional care management CPT codes become essential.

Why Transitional Care Management Is Essential

Patients leaving acute care settings face increased risk of readmission, medication errors, and complications. Transitional care management (TCM) services bridge this gap by ensuring timely follow-up, coordinated communication, and proactive care planning. For primary care providers, specialists, and nursing home directors, TCM serves as a structured framework to deliver high-value, patient-centered care while reducing preventable readmissions.

In addition, TCM offers substantial reimbursement opportunities for medical practices when services are documented and billed correctly. This financial support encourages practices to invest more in patient outreach, clinical staff, and care coordination tools.

How Transitional Care Management CPT Codes Work

Transitional care management services are billed using two main CPT codes:

• CPT 99495 – Moderate complexity TCM

  • Requires patient communication within 2 business days and a face-to-face visit within 14 days.

• CPT 99496 – High complexity TCM

  • Requires patient communication within 2 business days and a face-to-face visit within 7 days.

To qualify for TCM billing, providers must complete three essential components:

1. Interactive Contact
   A phone call, email, or other communication with the patient or caregiver within two business days of discharge.

2. Non-Face-to-Face Care Coordination
   This may include reviewing discharge summaries, scheduling follow-ups, coordinating with specialists, or adjusting medications.

3. Face-to-Face Visit
   Scheduled within 7 or 14 days based on complexity.

These guidelines ensure that providers deliver structured, timely care while maintaining compliance with CMS regulations.

Who Benefits Most from TCM Services?

Primary Care Providers
PCPs play a central role in coordinating post-discharge care, making TCM billing an effective way to enhance both patient safety and practice revenue.

Cardiologists
Transition periods for heart failure, arrhythmia, or post-cardiac procedures are high-risk. TCM ensures cardiology patients receive the close monitoring they need.

Endocrinologists
Patients discharged after diabetic crises or endocrine-related complications require careful medication management—TCM helps prevent relapse.

Pulmonologists
Those treated for COPD exacerbations or respiratory failure benefit from structured follow-up to prevent hospital readmissions.

Nursing Home Directors
TCM promotes continuity between facilities and outpatient providers, improving communication and reducing complications.

Medical Practice Owners
For administrators, TCM is a scalable, revenue-generating service line that boosts patient satisfaction and long-term retention.

How CareIQ Helps You Maximize TCM Success

CareIQ simplifies transitional care management by automating outreach, tracking compliance, and organizing patient follow-ups. With intuitive workflows, care coordinators and clinicians can spend more time helping patients and less time chasing paperwork. CareIQ ensures your practice captures every eligible TCM opportunity while improving care quality and operational efficiency.