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July 23, 2013 - Revised: 05.13.16

Transitional Care Management (TCM): Guidance

CMS has developed several Frequently Asked Questions (and answers) regarding transitional care management (TCM) codes (CPT codes 99495 and 99496). These codes are used to report physician or qualifying non-practitioner care management services for patients following discharge from a hospital, Skilled Nursing Facility (SNF), or Community Mental Health Center (CMHC) stay, outpatient observation, or partial hospitalization. Please refer to these CMS FAQsExternal PDF for guidance regarding these and other specific topics:

  • Reporting the correct Date of Service (DOS)
  • Reporting the correct Place of Service (POS)
  • Incident-to billing
  • Services provided in Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs)
  • Readmission
  • Claims from multiple providers
  • Applicability to teaching settings under the primary care exception rule
  • Separate payment for additional services
  • Definition of a "business day"

Reference: CMS Fact Sheet on Transitional Care ManagementExternal PDF

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