CMS October 2026Physician Fee Schedule · Free lookup

CPT 99496 Medicare Fee Schedule 2026

Medicare's 2026 national payment for CPT 99496 is $298.60 in a non-facility setting ($166.34 in a facility), up 9.5% from $272.68 in 2025.

National rate, October 2026

Non-facility: $298.60
Facility: $166.34
vs. 2025: +9.5%
Commercial national avg.: $326.39

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HCPCS Codes

99496

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Year

20262025

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Up to 5 codes · 4 remaining

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Physician Fee Schedule·99496·National·2026, 2025

Current non-facility rate

$298.60▲0.0%

Facility: $166.34

Recent trend

Code description

Transj Care Mgmt High F2f 7d, Transitional Care Management Services With The Following Required Elements Communication Direct Contact Telephone Electronic With The Patient And Or Caregiver Within 2 Business Days Of Discharge High Level Of Medical Decision Making During The Service Period Face To Face Visit Within 7 Calendar Days Of Discharge

Code	Date	State	Non-Facility Fee	Facility Fee	Description
99496	10/2026	N/A	$298.60	$166.34	Transj Care Mgmt High F2f 7d, Transitional Care Management Services With The Following Required Elements Communication Direct Contact Telephone Electronic With The Patient And Or Caregiver Within 2 Business Days Of Discharge High Level Of Medical Decision Making During The Service Period Face To Face Visit Within 7 Calendar Days Of Discharge
99496	7/2026	N/A	$298.60	$166.34	Transj Care Mgmt High F2f 7d, Transitional Care Management Services With The Following Required Elements Communication Direct Contact Telephone Electronic With The Patient And Or Caregiver Within 2 Business Days Of Discharge High Level Of Medical Decision Making During The Service Period Face To Face Visit Within 7 Calendar Days Of Discharge
99496	4/2026	N/A	$298.60	$166.34	Transj Care Mgmt High F2f 7d, Transitional Care Management Services With The Following Required Elements Communication Direct Contact Telephone Electronic With The Patient And Or Caregiver Within 2 Business Days Of Discharge High Level Of Medical Decision Making During The Service Period Face To Face Visit Within 7 Calendar Days Of Discharge
99496	1/2026	N/A	$298.60	$166.34	Transj Care Mgmt High F2f 7d, Transitional Care Management Services With The Following Required Elements Communication Direct Contact Telephone Electronic With The Patient And Or Caregiver Within 2 Business Days Of Discharge High Level Of Medical Decision Making During The Service Period Face To Face Visit Within 7 Calendar Days Of Discharge
99496	10/2025	N/A	$272.68	$182.43	Transj Care Mgmt High F2f 7d, Transitional Care Management Services With The Following Required Elements Communication Direct Contact Telephone Electronic With The Patient And Or Caregiver Within 2 Business Days Of Discharge High Level Of Medical Decision Making During The Service Period Face To Face Visit Within 7 Calendar Days Of Discharge
99496	7/2025	N/A	$272.68	$182.43	Transj Care Mgmt High F2f 7d, Transitional Care Management Services With The Following Required Elements Communication Direct Contact Telephone Electronic With The Patient And Or Caregiver Within 2 Business Days Of Discharge High Level Of Medical Decision Making During The Service Period Face To Face Visit Within 7 Calendar Days Of Discharge
99496	4/2025	N/A	$272.68	$182.43	Transj Care Mgmt High F2f 7d, Transitional Care Management Services With The Following Required Elements Communication Direct Contact Telephone Electronic With The Patient And Or Caregiver Within 2 Business Days Of Discharge High Level Of Medical Decision Making During The Service Period Face To Face Visit Within 7 Calendar Days Of Discharge
99496	1/2025	N/A	$272.68	$182.43	Transj Care Mgmt High F2f 7d, Transitional Care Management Services With The Following Required Elements Communication Direct Contact Telephone Electronic With The Patient And Or Caregiver Within 2 Business Days Of Discharge High Level Of Medical Decision Making During The Service Period Face To Face Visit Within 7 Calendar Days Of Discharge

99496 national rate by year

Each row is the latest CMS file published that year. Change is against the year before.

CMS file	Non-facility	Facility	Change
October 2026	$298.60	$166.34	+9.5%
October 2025	$272.68	$182.43	-2.5%
March 2024	$279.62	$188.07	+0.5%
January 2023	$278.21	$190.79	-1.2%
July 2022	$281.69	$195.87	-

This is the national amount before geographic adjustment. Medicare multiplies each relative value unit by its locality's geographic practice cost index, so a practice's own allowed amount can be higher or lower; pick a state above to see its localities. The facility amount applies when the service is performed in a hospital or other facility setting.

99496: Medicare vs. commercial national average

The commercial national average for 99496, the mean of what BCBS, UnitedHealthcare, Aetna and Cigna publish nationwide, is $326.39, 109% of Medicare's $298.60.

BCBS $291.98
UnitedHealthcare $303.80
Aetna $300.75
Cigna $409.03

A national average, not a local rate: each payer's figure averages the unmodified, in-network professional rates it publishes for 99496 across the country in its transparency files. Contracted rates vary widely by market, provider and plan. Medicare's figure is its national non-facility amount before geographic adjustment.

See commercial rates in your market Commercial rates for 99496

Nearby codes

99458 Medicare rate 99459 Medicare rate 99487 Medicare rate 99490 Medicare rate 99495 Medicare rate 99497 Medicare rate

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Medicaid comparison

See what state Medicaid programs pay for 99496

50 state Medicaid agencies publish their own physician fee schedule. The 99496 page shows real published rates for several of them free, with effective dates and official sources.

17,674 codes and 974,327 published rates, taken from the files the state agencies publish themselves.

See Medicaid rates for 99496

$220.11

99497Advncd Care Plan 30 Min, Advance Care Planning Including The Explanation And Discussion Of Advance Directives Such As Standard Forms With Completion Of Such Forms When Performed By The Physician Or Other Qualified Health Care Professional First 30 Minutes Face To Face With The Patient Family Member S And Or Surrogate

$86.84

99498Advncd Care Plan Addl 30 Min, Advance Care Planning Including The Explanation And Discussion Of Advance Directives Such As Standard Forms With Completion Of Such Forms When Performed By The Physician Or Other Qualified Health Care Professional Each Additional 30 Minutes List Separately In Addition To Code For Primary Procedure

$78.16

Methodology

Rates are sourced directly from CMS Physician Fee Schedule files, indexed quarterly. Non-facility and facility prices are calculated using the published GPCI for each locality and the year's conversion factor.

View CMS Physician Fee Schedule