CPT® Code 99495 is used to report transitional care management (TCM) services delivered to patients who have been discharged from a hospital or other qualified facility and require moderate-complexity follow-up within 14 days. This code supports the essential work of coordinating post-discharge care, preventing complications, and ensuring safe transitions back into the community. It reflects the clinical time, communication, and care planning needed during one of the most vulnerable windows for patient health.
99495 is billed when a physician or qualified healthcare professional provides structured post-discharge support—beginning with initial contact within two business days and followed by a face-to-face encounter within 14 days. It is commonly used for patients with chronic conditions, medication changes, new diagnoses, or moderate risk of readmission.
Key facts about CPT Code 99495
Service type: Transitional care management (TCM)
Provider type: Physicians and qualified healthcare professionals
Medical services included: Yes—review of discharge information, medication reconciliation, care coordination, and a post-discharge office or telehealth visit
Typical timeframe:
- Initial communication: Within 2 business days of discharge
- Face-to-face visit: Within 14 days
- Complexity level: Moderate medical decision making
Common uses:
- Managing chronic conditions that require careful medication or treatment adjustments after hospitalization
- Follow-up after new diagnoses or acute illnesses requiring close monitoring
- Coordinating care with specialists, home health agencies, or rehabilitation programs
- Ensuring safe transitions after surgical procedures or emergency care
- Reviewing test results, discharge summaries, and new treatment plans
When to use CPT Code 99495
CPT 99495 is appropriate when:
- A patient has been discharged from inpatient care, observation status, skilled nursing, or partial hospitalization.
- The provider or clinical team initiates communication (phone, portal, email, or direct contact) within two business days of discharge.
- The patient receives a face-to-face visit within 14 days, which may occur in-person or via telehealth if allowed by the payer.
- The provider completes moderate-complexity medical decision making.
Covered services may include medication reconciliation, diagnostic planning, symptom management, referrals, coordination with community agencies, and reviewing or updating the care plan. All non-face-to-face work performed during the 14-day period counts toward the service.
Documentation requirements
To accurately bill CPT 99495, documentation should clearly reflect:
- Date of discharge and source facility
- Mode and date of initial post-discharge communication
- Date and method of the required face-to-face visit
- Total time and activities performed during the TCM period
- Medication reconciliation, including any updates
- Moderate medical decision making, supported by:
- Number and complexity of problems
- Data reviewed or ordered
- Risk of complications, morbidity, or mortality
- Care coordination efforts, such as referral management, caregiver communication, or specialist collaboration
Payers may also require proof that communication occurred within the required two-day window.
Reimbursement and coding considerations
CPT 99495 is reimbursed by most commercial insurers, Medicaid programs, and Medicare (when requirements are met). Reimbursement reflects the bundled nature of TCM services—combining communication, care coordination, and the face-to-face visit into one comprehensive code.
Important considerations:
- Cannot be billed with certain care-management codes on the same date
- Provider must be the one assuming ongoing care responsibility
- Only one clinician may bill TCM per discharge
- All requirements (communication + visit + MDM level) must be met
- Telehealth for the 14-day visit may be accepted depending on payer
Always verify payer-specific rules on telehealth use, modifiers, or documentation format.
How OptiMantra supports Transitional Care Management
For integrative, primary care, and specialty practices managing complex transitions of care, OptiMantra makes it simple to track, document, and bill CPT 99495 with precision and ease.
With OptiMantra, providers can:
- Log outreach attempts and patient responses directly in the chart
- Use built-in or create custom templates that align with CPT code documentation requirements
- Streamline medication reconciliation with clean, organized medication views
- Document non-face-to-face TCM work within the patient record
- Tie the completed TCM period directly to billing workflows
- Generate audit-ready notes that support clean claims and prevent denials
Whether your practice coordinates care for medically complex patients or regularly supports post-hospitalization transitions, OptiMantra helps ensure accuracy, compliance, and full reimbursement—without adding administrative burden.
Try OptiMantra for free here!
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