From billing TCM CPT Codes to reducing hospitalizations, rely on HealthArc’s TCM platform to provide the right care to transitioning patients, and boost your clinical revenue and reimbursements.

Brief Overview of the Latest Transitional Care Management (TCM) CPT Codes for 2026

There are two major TCM CPT Codes, based on the level of medical decision-making (MDM) and when the required face-to-face visit will take place.

CPT 99495 – Moderate Complexity TCM

Covers transitional care management with moderate complexity medical decision-making.
Requires a face-to-face visit within 14 calendar days of discharge.
Requires interactive patient/caregiver contact within 2 business days of discharge.
Covers non-face-to-face services (i.e., review of discharge summaries, medication reconciliation, and coordination of care).

CPT 99496 – High Complexity TCM

Covers transitional care management with high complexity medical decision-making.
Requires a face-to-face visit within 7 calendar days of discharge.
Includes the same requirements as 99495 (patient/caregiver contact within 2 business days and extensive non-face-to-face coordination).
Intended for patients at higher risk of complications, readmission, or adverse medical events.

Who Can Bill for TCM?

Both the TCM CPT codes can be reported and billed by:

Physicians (MD, DO)
Nurse Practitioners (NPs)
Physician Assistants (PAs)
Certified Nurse Midwives (CNMs)
Clinical Nurse Specialists (CNSs)

Clinical staff can assist with coordination, but the billing provider must document and supervise care and is responsible for maintaining HIPAA and SoC2 compliance.

Latest Medicare Reimbursement for TCM Services in 2025

Latest Medicare Reimbursement for TCM Services in 2026

Medicare reimbursement for the commonly billed TCM codes:

99495: ~$180–$200 per patient per episode (approx.)
99496: ~$230–$250 per patient per episode (approx.)

Note: Rates vary by region and billing practitioner. Commercial payers may reimburse at different rates. All reimbursements must adhere to CMS guidelines.