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Transitional Care Mnagement

Better Health, Fewer Hospital Stays for Vulnerable Patients

With TCM, providers effectively coordinate care for 30 days after discharge, resulting in a significant reduction in hospital readmissions.

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$513.6 B

Global Market Value

50%+

Insurance Coverage

21%

Reduced Medication Use

38.5%

Acupuncture for Pain

Care Coordination for Value-Based Care Success

A platform for implementing, managing, and documenting TCM services to secure optimal Medicare incentive payments.
  • Live dashboards provide immediate tracking and management of clinical and operational workflows
  • CPT codes and conditions are automatically applied to claims, reflecting the complexity of medical decision-making.
  • Detailed audit trails are generated for all documented TCM services, ensuring accuracy for billing and claims processing.

Track time-sensitive service requirements.

Create and share comprehensive discharge reports.

Capture reimbursement from Medicare with accurate billing support.

Address hospital readmissions by closing gaps in patient care transitions

We are geared to disrupt the industry and alter the ways healthcare is provided

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Patients That We Enroll

Eligibility Criteria for the TCM Patient

Discharge from an inpatient setting

Discharge to a home/community setting

Medical complexity (within 30 days post-discharge)

No overlapping programs

  • The patient must be discharged from one of the following facilities:

    • An Inpatient Hospital Stay

    • A Skilled Nursing Facility (SNF) or Nursing Facility

    • A Community Mental Health Center (CMHC)

    • A Partial Hospitalization Program (PHP)

  • The patient’s condition must require the physician or qualified healthcare professional (QHP) to perform specific services needed within 30 days of the discharge date.

How does TCM work?

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CPT Billing Codes and Reimbursement for TCM

CPT-99495  (Moderate Complexity*)

Face-to-face visit within 14 days of discharge

RVU 2.11

$201.20

Medicare National Payment Amount (2025)

CPT-99496  (High Complexity*)

Face-to-face visit within 7 days of discharge

RVU 3.79

$272.68

Medicare National Payment Amount (2025)

*Reimbursement rates are based on a national average and may vary depending on your location. Check https://www.cms.gov/medicare/physician-fee-schedule/search/ for the latest information.

Profitable TCM Reimbursements from Medicare

~$96.00

Average Reimbursement Rate per 45-minute Acupuncture Session (CPT 97810 + 97811 x 2)
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hr-group icon

500

Total Reimbursable Acupuncture Sessions per Month.

~$48,000

Monthly reimbursement.

Frequently Asked Questions

What is Transitional Care Management (TCM)?

TCM is a set of services provided to a patient for 30 days following their discharge from a hospital, skilled nursing facility (SNF), or other inpatient settings, to help them safely transition back home. The goal is to reduce complications, prevent hospital readmissions, and ensure continuity of care.

Which patients are eligible for TCM?

Any patient who is discharged from a qualifying facility (hospital, SNF, partial hospitalization) to a home or community setting (private residence, assisted living) and requires at least moderate medical decision-making during the 30-day period.

Does the patient have to be a new patient?

No. TCM can be billed for both new and established patients who meet the eligibility criteria.

What are the two levels of TCM service?

There are two CPT codes based on the complexity of care required: CPT 99495 (Moderate Complexity) and CPT 99496 (High Complexity). The required timeframe for the face-to-face visit determines the code.

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