What are the requirements for billing Medicare TCM (99495/99496)?

Transitional Care Management requires: patient contact within 2 business days of discharge, face-to-face visit within 7 days (99495) or 14 days (99496), and interactive contact (phone or in-person, not portal message) to establish the post-discharge care plan. Documentation must include medication reconciliation, medical decision-making complexity, and care coordination activities. Only one provider can bill TCM per discharge.

What is the difference between TCM codes 99495 and 99496?

99495 requires moderate complexity MDM with face-to-face visit within 7 days of discharge. 99496 requires high complexity MDM with face-to-face visit within 14 days. Both require communication within 2 business days and medication reconciliation. High complexity includes acute illness with systemic symptoms, chronic illness with severe exacerbation, or conditions requiring drug therapy requiring intensive monitoring.

What medication reconciliation documentation is required for TCM?

Document: review of discharge medication list, comparison to pre-admission medications, identification of discrepancies, changes made (dose adjustments, new medications, discontinued medications), patient/caregiver education on medication changes, assessment of adherence barriers, and any necessary prior authorizations. This reconciliation should address all medications, not just those related to hospitalization.

How should readmission risk assessment be documented?

Document: specific readmission risk factors (polypharmacy, multiple comorbidities, poor social support, functional decline, previous readmissions), actions taken to mitigate risks (care coordination, home health referral, medication education), patient and family education on warning signs, and follow-up plan. High-risk patients may benefit from more intensive post-discharge monitoring.

Can TCM be billed with other care management services?

TCM cannot be billed in the same service period as CCM (99490), BHI (99484), or PCM (99426-99427). It can be billed with E/M services using modifier 25 if a separate significant problem is addressed. TCM covers 30 days post-discharge; after that period, CCM or other services can begin. Only one TCM service per discharge, regardless of number of providers involved.

Post-Hospital Follow-up Template - TCM Visit

Internal Medicine — Post-Hospital Follow-up Template

Internal Medicine Internal Medicine Updated: 11/7/2025

The Post-Hospital Follow-up Template is designed for primary care providers and internists conducting follow-up visits within 7-14 days after hospital discharge. This template supports Medicare Transitional Care Management (TCM) billing requirements and ensures comprehensive documentation of post-discharge recovery, medication reconciliation, care coordination, and readmission prevention. The template includes sections for hospitalization summary and discharge diagnoses, post-discharge recovery including symptoms and functional status, medication reconciliation with comparison to pre-admission medications, follow-up on pending test results, specialist follow-up status, care coordination needs, assessment of recovery and complications, treatment plan adjustments, patient education on warning signs and when to seek care, and scheduling of additional follow-up if needed. This template ensures quality care transitions, supports TCM billing, reduces readmission risk, and improves patient outcomes through systematic post-discharge care. Ideal for primary care practices, internal medicine practices, and practices managing high volumes of post-discharge patients.

Visit Information

Hospitalization dates: [Admission - Discharge]
Days since discharge: [X] days
Discharge diagnoses: [List primary diagnoses]
Discharging service: [Service/Team]

Post-Discharge Recovery

Symptoms: [Current symptoms, improvement, new concerns]
Functional status: [Activity level, mobility, ADLs]
Pain: [Level if applicable]
Overall recovery: [Patient's assessment]

Medication Reconciliation

Pre-admission medications: [List]
Discharge medications: [List]
Current medications: [List]
Changes: [New medications, discontinued, dose changes]
Adherence: Taking as prescribed / Barriers: [specify]
Side effects: None / [Specify]

Follow-up Status

Specialist appointments: [Scheduled / Completed / Pending]
Pending test results: [List and who will follow up]
Home health: [If applicable]
Other services: [PT, OT, etc. if applicable]

Physical Examination

Vital signs: BP, HR, RR, Temp, SpO2, Weight
Focused exam: [Relevant to discharge diagnoses]

Assessment

1) Post-discharge status, [X] days

Recovery: Going well / Concerns: [specify]
Complications: None / [Specify if present]

2) [Discharge diagnoses] — Status: [Improved / Stable / Worsened]
3) [Other diagnoses]

Plan

1) Continue discharge medications / Adjustments: [specify]
2) Follow-up on: [Pending tests, specialist visits]
3) Care coordination: [Actions needed]
4) Patient education: [Warning signs, when to seek care, medication adherence]
5) Follow-up: Return in [timeframe] / Sooner if: [specify]

Patient Instructions

Recovery expectations reviewed. Warning signs discussed. Medication plan reviewed. Patient verbalized understanding.

Internal Medicine — Post-Hospital Follow-up Template

Template