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:
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.