99495 and 99496 are current procedural terminology (CPT®) codes that describe Transitional Care Management Services (TCM). TCM services are performed during transitions in care from an inpatient hospital setting (including acute hospital, rehabilitation  hospital, long-term acute care hospital), partial hospital, observation status in a hospital, or skilled nursing facility/ nursing facility, to the patient's community setting (home, domiciliary, rest home, or assisted living). These services are for established patients with medical and/or psychosocial problems that require moderate or high complexity medical decision making. The individual reporting these services provides or oversees the management and/or coordination of services for all medical conditions, psychosocial needs, and activities of daily living support by providing first contact and continuous access.

Transitional Care Services must include the following required elements:

 ATC Oct ReveNews

Proper documentation of TCM services includes the timing of the initial post-discharge communication with the patient or the caregiver(s), the date of the face-to-face visit, and the complexity of medical decision making, in addition to the content of the face-to-face and non-face-to-face services provided during the calendar month.

1 2015 AMA Professional Edition CPT® current procedural terminology pages 48-49.
2 Ibid.

CPT Assistant Archives (4th Quarter 1990 - present) – American Medical Association
2013 Transitional Care Management Services (April 2013, Volume 23, Issue 4, pages 3-4)

Author - Female

About the author

Stephanie Johnson, CHC, RHIT, CPC, CPEDS is Compliance Manager – Academic, Office-based and Multi-specialty Physicians of McKesson Business Performance Services.