2026 Transitional Care Management CPT Codes and Reimbursement

CMS has updated the CPT codes for Transitional Care Management (TCM) for 2026 and there are some substantial updates for reimbursement rates! In this video, we’ll dive deep into everything to know to properly code and bill for this program. 

Download a reference guide for the TCM CPT codes. 

CPT code reimbursement rates are based on national averages, which may vary by location. Visit the Physician Fee Schedule website for the exact current rate based on your location.

Transitional Care Management helps patients avoid readmissions. It supports patients in the first 30 days after a discharge through interactive contact, non-face-to-face services, and an office visit. If a patient is not readmitted after 30 days and these three segments of TCM have been completed, services can be billed.

There are two CPT codes for Transitional Care Management, with each based on the complexity of medical decision-making. Only one code can be billed per patient per program based on the complexity. It’s up to the provider to determine the level of medical decision-making, but factors can include:

• How many possible diagnoses and/or the amount of care management options need to be considered
• The complexity of medical records, tests, and other information that needs to be acquired and analyzed
• The risk of significant complications with the patient’s conditions
  

TCM Moderate Complexity CPT Code

For Moderate Complexity, bill code 99495. For this code, the patient will need to be outreached within the first 48 hours of discharge and the face-to-face office visit must occur within 14 days of discharge. The national average reimbursement for 99495 is $220, which is a 10% increase from 2025.

TCM High Complexity CPT Code

For high complexity, bill code 99496. For this code, the patient needs to be outreached within the first 48 hours of discharge, but the face-to-face office visit will need to occur within 7 days of discharge. The national average reimbursement for 99496 is $298, a 10% increase from 2025 as well.

With the reimbursement increases this year, there’s a great opportunity to grow your program and offer this valuable service to more patients.  Reach out to ThoroughCare if you need help in starting or growing your TCM program.