CPT 99495: TCM, 14-day visit
Covers the 30 days after a hospital or facility discharge when decision-making is at least moderate and the face-to-face visit happens within 14 days.
CPT 99495 at a glance
- Time threshold
- Contact within 2 business days; visit within 14 days
- Who performs it
- Practitioner for the visit; clinical staff for outreach
- How often
- Once per patient in the 30 days after discharge
- Approx. 2026 national rate
- ~$220
Only one TCM code is reported per patient per 30-day period.
What the record needs to show
- Interactive contact with the patient or caregiver within 2 business days of discharge
- A face-to-face visit within 14 calendar days
- Moderate or higher complexity decision-making documented
- Medication reconciliation on or before the visit date
- Review of the discharge information and needed follow-up
Common billing mistakes
- Missing the 2-business-day contact, which makes the episode non-billable
- Visit scheduled after day 14
- Two practitioners billing TCM for the same discharge
Where Zenith fits
Your practice stays the billing provider for CPT 99495. Zenith supplies trained clinical staff who do the work inside your EHR and invoice your practice for the labor. Zenith does not bill Medicare. See Transitional Care Management for how the program runs.
Educational summary, not billing or legal advice. Rates are 2026 Medicare national averages and vary by locality and payer. Confirm current rules in the CMS Physician Fee Schedule and with your Medicare Administrative Contractor.