Skip to Main Content

September 8, 2026

REMINDER: Chronic Care Management (CCM) and Transitional Care Management (TCM) Services

We've recently seen an increase in provider inquiries related to billing and submission requirements for Chronic Care Management (CCM) and Transitional Care Management (TCM) services. To help address common questions, please review the following information from the CMS Chronic Care Management Fact Sheet:

  • As stated on page 1 of the CMS CCM Fact Sheet, Chronic Care Management services consist of at least 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month.
  • Billing TCM Services
    • Only 1 physician or NPP may report TCM services.
    • Report services once per patient during the TCM period.
    • The same health care professional may discharge the patient from the hospital, report hospital or observation discharge services, and bill TCM services. The required face-to-face visit can’t take place on the same day you report discharge day management services.
    • Report reasonable and necessary E/M services (except the required face-to-face visit) to manage the patient’s clinical issues separately.
    • You can’t bill TCM services within a post-operative global surgery period (we don’t pay for TCM services if any of the 30-day TCM period falls within a global surgery period for a procedure code billed by the same practitioner).
    • At a minimum, document this information in the patient’s medical record:
    • Patient discharge date
    • Patient or caregiver first interactive contact date
    • Face-to-face visit date
    • Medical decision making (moderate or high)

Please also consult the CPT Manual for additional codes that cannot be billed during the same service period as CPT code 99490. Additional restrictions may apply for practitioners participating in CMS-sponsored models or demonstration programs.

Claims should be submitted with the date of service on which the 20-minute requirement was fulfilled.

CCM Services Fact SheetExternal PDF

TCM Services Fact SheetExternal PDF

CGS, Part B – Browse by Topic (Chronic Care Management)

spacer

26 Century Blvd, Suite NT600, Nashville, TN 37214 © CGS Administrators, LLC. All Rights Reserved