TCM Guide: 2026 Codes, Requirements & Billing Rules

What is Transitional Care Management (TCM)?

Transitional Care Management (TCM) is a Medicare service for the 30 days after a patient is discharged from a qualifying facility stay. It requires contact within two business days of discharge, a clinician visit within 7 or 14 days, and coordination through the transition.

Which patients qualify for TCM?

A patient is returning to a community setting after discharge from a qualifying inpatient or partial-hospital setting.
The patient needs moderate- or high-complexity medical decision-making during the transition period.
Medication reconciliation, follow-up appointments, referrals, education, or community support require coordinated action.

What are the TCM codes?

The TCM codes are 99495 and 99496.

Code	Covers	2026 national office benchmark
99495	Moderate complexity: Clinical visit within 14 days	$220.11 / qualifying transition
99496	High complexity: Clinical visit within 7 days	$298.60 / qualifying transition

One qualifying transition uses one TCM code. Required contact is within two business days of discharge. Medication reconciliation, visit timing, medical decision-making and other requirements must be met.

2026 Medicare allowed amounts, national office/nonfacility benchmark, non-QP conversion factor. Includes applicable patient cost sharing; before practice costs and MySeema fees. Actual collections vary with location, setting, clinician, coverage, and claim adjustments. See the rate source and estimate your practice.

TCM billing rules

One claim by one practitioner per patient for the 30-day transition episode.
Contact patient/caregiver within two business days; CMS permits documented timely unsuccessful attempts if remaining requirements are met.
99495 requires moderate-or-higher medical decision making and a visit within 14 calendar days; 99496 requires high complexity and a visit within 7 days.
Reconcile/manage medication no later than the required visit; that visit is included in the episode payment.
Do not bill both episode codes; avoid overlapping episodes and same-practitioner postoperative global periods.

Patient cost sharing and protections depend on coverage and the service. Explain them before consent. RHC/FQHC payment rules and Medicare Advantage contracts differ from the national benchmark.

What a practice needs before starting TCM

Reliable, timely discharge notification and transfer of discharge information
Named billing practitioner and clinical owner for the 30-day period
Workflow for timely contact, visit scheduling, and medication reconciliation
Documented roles for non-face-to-face coordination and clinical escalation
Contingency plan for unsuccessful contact and non-qualifying discharges

Who does what in a supported TCM program

Your practice or organization

Confirm the discharge setting qualifies, accept responsibility for the transition, and perform the required medical decision-making.
Complete the required face-to-face visit and medication reconciliation within the applicable timeframe.
Provide timely discharge information, direct clinical staff, and validate documentation and billing for the full TCM period.

A support partner such as MySeema

Act on the partner's discharge notification and support the required timely contact workflow.
Coordinate appointments, referrals, requested records, and practical resources while tracking unresolved discharge tasks.
Document outreach and handoffs, and route status changes or medication questions to the responsible clinical team.

Your clinicians keep clinical decisions and oversight, and your organization bills eligible services.

What changes for TCM in 2027?

The benchmarks on this page are 2026 amounts. Medicare’s 2027 conversion factor is lower ($32.63 for most clinicians, down 2.31%), so 2027 payment amounts will differ. Read what the 2027 fee schedule changes.

Common questions about TCM

Is TCM a recurring monthly program?

No. TCM is tied to a qualifying discharge and covers the 30-day period that begins on the discharge date. Ongoing needs after that period may fit another service, but that requires a separate assessment.

Can coordination replace the required clinical visit?

No. The billing practitioner must meet the applicable face-to-face visit and medical decision-making requirements. MySeema can support the surrounding outreach and follow-through defined in the partner workflow.

What happens if the patient cannot be reached?

CMS describes timely contact attempts and documentation requirements. The team should keep trying to reach the patient and must still meet the other service requirements for TCM billing.

This guide summarizes Medicare requirements for planning. It is not a billing manual or a promise of reimbursement. Confirm requirements with your billing and compliance teams.

Transitional Care Management (TCM): codes, requirements, and how it works