Healthcare Glossary→Transitional Care Management
Care Coordination

Transitional Care Management (TCM)

Transitional Care Management services cover structured post-discharge follow-up for Medicare patients discharged from inpatient, SNF, LTCH, IRF, or ED settings with moderate or high medical decision complexity.

What is Transitional Care Management?

TCM billing covers the 30-day period following discharge from an acute inpatient hospital, skilled nursing facility, long-term acute care hospital, inpatient rehabilitation facility, or emergency department. Two CPT codes apply: 99495 (moderate medical decision complexity — face-to-face visit required within 14 days, average Medicare payment $165–180) and 99496 (high medical decision complexity — face-to-face visit required within 7 days, average payment $230–250). Both require an interactive contact attempt within 2 business days of discharge — by phone, secure email, or electronic health record portal message — and non-face-to-face care coordination services during the 30-day period. TCM cannot be billed if the patient is in a SNF or under hospice, and cannot be billed on the same day as a routine E/M visit. The average practice with 100 TCM-eligible discharges per month that is not billing TCM misses $15,000–30,000 per month in Medicare revenue.

Why It Matters for Healthcare Analytics

The most common TCM revenue leak is not billing at all — practices either lack a systematic process to identify eligible discharges or fail to document the 2-business-day contact attempt. Tracking the gap between TCM-eligible discharges and submitted TCM claims, along with face-to-face visit completion within the required window, is essential to capture this revenue and support readmission prevention goals simultaneously.

How Vizier Tracks TCM

Upload your discharge data and billing export, then ask "How many TCM-eligible discharges did we have last month and what percentage were billed?" — Vizier calculates your TCM capture rate, estimates missed revenue, and flags patients whose 7- or 14-day visit window is approaching, without requiring custom reports from your billing team.