CPT 99495: Transitional Care Management, Moderate Complexity
CPT 99495 reports moderate-complexity transitional care management (TCM) after discharge, requiring contact within 2 business days and a face-to-face visit within 14 days. In 2026 Medicare pays about $220.11 non-facility (6.59 total RVUs times the $33.4009 conversion factor) and about $122.25 in a facility.
- Code type
- Transitional care management (moderate)
- 2026 non-facility
- $220.11 (6.59 RVUs)
- 2026 facility
- $122.25 (3.66 RVUs)
- Requirement
- Contact <=2 days, visit <=14 days
What is CPT 99495 used for?
CPT 99495 reports moderate-complexity transitional care management (TCM), the coordination of care as a patient moves from an inpatient or observation setting back to the community. It bundles a post-discharge face-to-face visit and 30 days of care coordination, aimed at preventing readmissions during the risky transition window.
The 30-day TCM period begins on the discharge date. Three elements must be met: interactive contact with the patient or caregiver within 2 business days of discharge, moderate-complexity medical decision making during the service period, and a face-to-face visit within 14 calendar days of discharge. The complexity of the decision making and the timing of that visit are what separate 99495 from the high-complexity 99496.
How much does 99495 pay in 2026?
99495 carries 6.59 non-facility RVUs and 3.66 facility RVUs. At the 2026 conversion factor of $33.4009 that is about $220.11 non-facility and $122.25 in a facility. Because it captures the visit plus a month of coordination, it pays well above a standalone office visit such as 99214. Model it on the Medicare fee calculator.
What are the TCM timing rules?
| Requirement | 99495 (moderate) | 99496 (high) |
|---|---|---|
| Interactive contact | Within 2 business days | Within 2 business days |
| Face-to-face visit | Within 14 days | Within 7 days |
| MDM | Moderate | High |
Example: a patient discharged after a COPD admission is phoned within 2 business days, seen face-to-face on day 9 with moderate-complexity medication and follow-up decisions, and coordinated for the balance of the 30 days. That supports 99495 at about $220.11.
Frequently asked questions
99495 requires interactive contact (phone, email, or in person) with the patient or caregiver within 2 business days of discharge, moderate-complexity medical decision making during the TCM service period, and a face-to-face visit within 14 calendar days of discharge. The 30-day TCM period begins on the discharge date.
The 2026 national non-facility allowed amount is about $220.11 (6.59 total RVUs times $33.4009) and about $122.25 in a facility. TCM is among the higher-paying care-coordination services because it bundles the post-discharge visit and 30 days of coordination.
Both are TCM. 99495 is moderate complexity with the face-to-face visit within 14 days. 99496 is high complexity with the visit within 7 days. The higher-acuity, faster-visit code (99496) pays more. Both require the 2-business-day interactive contact after discharge.
Sources & further reading
Reviewed by the ImmediCare Solutions RCM team
Certified billers and coders handling claims across 50+ specialties nationwide. This entry is reviewed against current payer policy and CMS rules. Last review: Jul 5, 2026.
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