99495
Transitional care management, moderate complexity
Interactive contact within two business days of discharge, medical decision making of at least moderate complexity, and a face-to-face visit within 14 calendar days of discharge.
CPT Codes
Transitional care management CPT codes: 99495 and 99496
Two codes cover the 30 day post-discharge period. Which one applies turns on the level of medical decision making and how quickly the face-to-face visit happens.
99496
Transitional care management, high complexity
Interactive contact within two business days of discharge, medical decision making of high complexity, and a face-to-face visit within seven calendar days of discharge.
The Window
When does the 30 day period start?
The 30 day transitional care management period begins on the date of discharge and runs for 29 further days. Every other requirement is timed from that same date.
Because the clock starts at discharge rather than at notification, a practice that learns about a discharge late has already spent part of the window. This is why discharge notification, not coding, is the first thing to solve when a program is built.
The two business day contact requirement is the tightest constraint in the set. It is interactive contact, meaning a live exchange with the patient or caregiver by telephone, in person or by another interactive method. A voicemail is an attempt, not a contact.
Unsuccessful Contact
What if the patient cannot be reached?
Two or more separate documented unsuccessful attempts within the two business day window still permit the service to be reported, provided the other requirements are met.
The documentation has to show genuinely separate attempts, not one call logged twice. This provision exists because patients are frequently unreachable in the days immediately after a discharge, and CMS did not intend that to void the service where the practice did the work.
Only one practitioner may report transitional care management for a given discharge. Where more than one entity is involved in the post-discharge work, that constraint divides the work but never the claim.
Who Performs It
Who can furnish each part of the service?
The non face-to-face work may be furnished by clinical staff under general supervision. The face-to-face visit must be furnished by the billing practitioner and requires at minimum direct supervision.
The billing practitioner may be a physician, nurse practitioner, physician assistant, clinical nurse specialist or certified nurse midwife, subject to state scope of practice. A nurse practitioner may furnish the face-to-face visit.
A pharmacist may not furnish the face-to-face visit. Pharmacists frequently perform the medication reconciliation that the service requires, and that work counts, but it does not satisfy the visit requirement.
Both codes are on the Medicare telehealth list. Eligibility rests on the telehealth list together with the originating site and geographic flexibilities in force at the time of service, which are extended by statute rather than being permanent. A program that depends on virtual visits at scale should confirm what is in effect for the plan year rather than assume it persists.
Common Questions
Related questions
What is the difference between 99495 and 99496?
Two things differ: the level of medical decision making and the deadline for the face-to-face visit. 99495 requires at least moderate complexity decision making and a visit within 14 calendar days. 99496 requires high complexity decision making and a visit within seven calendar days. The two business day interactive contact requirement is the same for both.
What level of medical decision making does 99495 require?
At least moderate complexity. It is a floor rather than a band, so a case with high complexity decision making that had its face-to-face visit on day ten is reported with 99495, because the visit timing did not meet the seven day requirement for 99496.
Can transitional care management and chronic care management be billed in the same month?
Usually not. CMS expects the two to fall in different calendar months. One exception exists: the 30 day transitional care management period must end before the end of the month, and at least 20 minutes of qualifying chronic care management must be furnished after it closes and within that same month. Rural health clinics and federally qualified health centers are treated differently.
Does the face-to-face visit have to be in person?
Not necessarily. Both codes are telehealth eligible, so the visit may be virtual where the telehealth list and the originating site and geographic flexibilities in force at the time of service permit it. The timing requirements are unchanged either way.
Can two practices bill transitional care management for the same discharge?
No. Only one practitioner may report transitional care management for a given discharge. Where a vendor or a second organization supports the work, it divides the labor but the claim stays with one billing practitioner, who retains responsibility for the documentation behind it.
Code descriptors reflect the AMA CPT code set and the CMS HCPCS code set current as of CY2026. Both are revised annually, and Medicare Administrative Contractor and commercial payer policy varies. This page describes what each code covers and the conditions attached to reporting it. It is a reference, not billing advice for a specific claim, and it carries no payment rates.
Related reading
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