Transitional Care Management (TCM)
Transitional Care Management
Care management following discharge from an inpatient, partial-hospital, or observation stay; CPT 99495 (moderate complexity) and 99496 (high complexity).
1 min read · Last reviewed May 23, 2026
At a glance
- Category
- Billing
- Acronym for
- Transitional Care Management
- Primary sources
- 1
- Workspace handoff
- revenue audit →
Where this comes up
This shows up in revenue-cycle work — claim scrubbing, charge entry, posting, A/R follow-up, and month-end close. Billers and practice managers hit this term when reconciling a payment, working a denial queue, or auditing why a claim aged past 60 days.
Full definition
What it is in practice
CMS covers TCM when interactive contact occurs within 2 business days of discharge, a face-to-face visit within 7 (high) or 14 (moderate) days, and non-face-to-face care management activities for 30 days post-discharge.
How it shows up in your practice
Build a discharge-list workflow with calls within 2 business days. The face-to-face visit is the visible deliverable; the supporting documentation drives the payment.
Sources
- CMS — Chronic Care Management Serviceshttps://www.cms.gov/outreach-and-education/medicare-learning-network-mln/mlnproducts/downloads/chroniccaremanagement.pdf
Capture TCM in Revenue Audit
Open revenue audit →Related terms
- BillingChronic Care Management (CCM)Care management services for Medicare beneficiaries with two or more chronic conditions; billed monthly under CPT 99490 and related codes.
- BillingPrincipal Care Management (PCM)Care management for Medicare beneficiaries with a single high-risk chronic condition; billed under CPT 99424-99427.
- DocumentationMedication ReconciliationThe process of creating an accurate list of all medications a patient is taking and comparing it against new orders to identify discrepancies.
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Reviewer status: a named credentialed reviewer (CHC, CHPC, or healthcare attorney) is being engaged. Until that engagement is finalized, this page does not claim credentialed review.
Related across the archive
- GlossaryChronic Care Management (CCM)Care management services for Medicare beneficiaries with two or more chronic conditions; billed monthly under CPT 99490 and related codes.
- GlossaryPrincipal Care Management (PCM)Care management for Medicare beneficiaries with a single high-risk chronic condition; billed under CPT 99424-99427.
- GlossaryMedication ReconciliationThe process of creating an accurate list of all medications a patient is taking and comparing it against new orders to identify discrepancies.
- GlossaryAdvance Care PlanningDiscussion and documentation of patient's goals, values, and preferences for future medical care; billable under CPT 99497 and 99498.
- GlossaryCollaborative Care Model (CoCM)Integrated primary-care behavioral-health model billable under CPT 99492-99494 and HCPCS G2214.
- BillingAWV + Problem Visit Same Day: How to Bill CorrectlyYes, you can bill AWV and a problem visit the same day. Here's how to do it correctly with modifier -25.
- BillingPlace of Service Codes: Which One to Use and Why It Changes Your ReimbursementPOS 11 vs 21 vs 02 vs 10. How the two-digit code on your claim determines whether you get office or facility rates.
- BillingUB-04 Billing: Bill Types, Revenue Codes, and Occurrence Codes ExplainedBill type 111 vs 131, revenue code 0250, occurrence span code 70. Every UB-04 field explained in plain English.
This glossary entry is a research aid for billing and compliance staff. It does not provide legal, medical, or financial advice and does not replace counsel. References cited link to primary sources at HHS, OCR, CMS, eCFR, NIST, and the relevant payer or industry body.