Can you bill an AWV and TCM together?

Asked by: Prof. Samir Hayes  |  Last update: August 13, 2025
Score: 4.1/5 (5 votes)

May a visit for TCM be performed and billed on the same date of service as an AWV ? Answer: The TCM appointment may take place on the same date as the AWV. It is important to note that all expected elements of both services must be documented in the medical record individually.

Can you bill TCM and office visit together?

Billing TCM Services

Only 1 physician or NPP may report TCM services. Report services once per patient during the TCM period. 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.

Can you bill 99495 and 99496 together?

There are two CPT codes for TCM reimbursement: 99495 and 99496. Only one code can be billed per patient per program completion. The most appropriate code is based on the complexity presented within the medical decision-making for the patient.

Can you bill G0439 and 99397 together?

These codes must be used for these services for Medicare beneficiaries. CPT codes 99381-99397 for comprehensive preventive medicine evaluation and management services should not be used to bill for Medicare services covered by HCPCS codes G0402, G0438 and G0439.

Can we code TCM and 99214 together?

Not if the 99214 visit is the one visit included in TCM. CPT states, " The first face-to-face visit is part of the TCM service and not reported separately. Additional E/M services provided on subsequent dates after the first face-to-face visit may be reported separately. "

What are Medicare's Rules and Requirements for Annual Wellness Visits (AWV)?

44 related questions found

Can TCM be billed with AWV?

May a visit for TCM be performed and billed on the same date of service as an AWV ? Answer: The TCM appointment may take place on the same date as the AWV. It is important to note that all expected elements of both services must be documented in the medical record individually.

Can an office visit and preventive visit be billed together?

CPT states that if a new or existing problem is assessed and managed at the time of the preventive visit, the physician should also bill a problem-oriented visit (an office visit) on the day of the preventive care.

Can you bill Medicare Wellness and Office Visit?

The CMS website states “When you provide an annual wellness visit and a significant, separately identifiable, medically necessary Evaluation and Management (E/M) service, Medicare may pay the additional service. Report the additional CPT code with Modifier-25.

Does an AWV have to be 12 months apart?

We cover only 1 IPPE per patient per lifetime and 1 additional AWV every 12 months after the date of the patient's last AWV (or IPPE). Check eligibility to find when a patient is eligible for their next preventive service.

Can you bill TCM after an ER visit?

Does an emergency department visit qualify for TCM? No. Emergency department visits are excluded. Patients are eligible for TCM services to help with the transition following discharge from inpatient or observation status, a nursing facility, or partial hospitalization.

Can you bill G0444 and G0439 together?

Additional AWV HCPCS and CPT Codes

For example, HCPCS G0444, which designates a 15-minute annual depression screening, may only be included with subsequent wellness visits billed under G0439. If that specific code is used with the IPPE or initial AWV, it will be rejected as invalid.

Can a TCM visit be done via telehealth?

As TCM activities do include a face-to-face service (see CMS Billing Lingo, Defined!), CMS does include the services in the Medicare telehealth services list. The non-face-to-face elements of TCM services may be provided in person or virtually (i.e., audio-visual or two-way audio technology), or a combination of both.

What are the guidelines for 99495 and 99496?

For 99496, the face-to-face visit must occur within 7 calendar days of the date discharge and medical decision-making must be of high complexity. For 99495, the face-to-face visit must occur within 14 calendar days of the date of discharge and medical decision-making must be of at least moderate complexity.

Can I bill CCM and TCM in the same month?

If both an E/M and the CCM code are billed on the same day, modifier -25 must be reported on the CCM claim. 13. Medicare and CPT specify that CCM and TCM cannot be billed during the same month.

How many times can 99495 be billed?

99495 and 99496. There are two CPT codes for TCM reimbursement: 99495 and 99496. Only one code can be billed per patient per TCM completion.

Can you bill 99214 and 99401 together?

Yes, you can bill CPT 99214 and 99401 together, provided that the services rendered meet the criteria for each code. CPT 99401 should be utilized for preventive counseling specifically related to obesity management, while CPT 99214 covers the office visit with moderate medical decision-making.

What is not covered in a Medicare annual wellness visit?

Medicare does not cover Annual Wellness Visits if they are used to discuss, plan, or alter treatment for pre-diagnosed chronic illnesses, including high cholesterol, high blood pressure, or arthritis.

Does 99459 need a modifier?

Reporting CPT Code 99459 With Modifier 25

That said, medical necessity is paramount. If a patient's pelvic examination is postponed to coincide with a cystoscopy and a justified medical need for an evaluation and management service exists during the procedure, it is considered reasonable to include it in the claim.

Can 99213 and 99455 be billed together?

Can I code 99455 for a work-related or medical disability evaluation as well as a regular office-visit code (such as 99213) for the same encounter, if it's appropriate? Yes. Code 99455 is one of three used to report evaluations required for life or disability insurance certificates.

Can you bill 99214 and G0439 together?

Medicare does discourage this and says there is too much 'crossover' between these two preventive services. We usually see a 99213 or 99214 with a G0438 or G0439 to represent the problem management outside the AWV. If you bill G0438/G0439 and a 99397, recognize that Medicare does not cover the 99397.

Can 2 office visits be billed same day?

Yes, in some cases, you can bill two E&M (Evaluation and Management) codes for the same patient on the same day, but it depends on payer rules and documentation requirements.

What documentation is required for TCM?

At a minimum, documentation for TCM must include: Date the patient was discharged. Date of the interactive contact with the patient and/or caregiver. Date of the face-to-face visit.

What qualifies as a TCM visit?

Transitional Care Management (TCM) services address the hand-off period between the inpatient and community setting. After a hospitalization or other inpatient facility stay (e.g., in a skilled nursing facility), the patient may be dealing with a medical crisis, new diagnosis, or change in medication therapy.

Who pays for transitional care?

Medicare Part B covers TCM, and out-of-pocket costs may apply. Programs that may provide financial assistance for transitional care costs include Medicaid, Medicare savings programs, PACE, and Extra Help.