CPT 99496: TCM, 7-day visit
The higher TCM code: high-complexity decision-making and a face-to-face visit within 7 days of discharge.
CPT 99496 at a glance
- Time threshold
- Contact within 2 business days; visit within 7 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
- ~$299
Only one TCM code is reported per patient per 30-day period.
What the record needs to show
- Interactive contact within 2 business days of discharge
- A face-to-face visit within 7 calendar days
- High complexity decision-making documented
- Medication reconciliation on or before the visit date
Common billing mistakes
- Using 99496 when the visit actually happened on day 8 to 14
- Weak documentation of high-complexity decision-making
Where Zenith fits
Your practice stays the billing provider for CPT 99496. 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.