Rate Benchmarking
Compare your rates with similar providers.
Select a published rate, define comparable providers, and see where that rate falls in your market.
See a sample rate comparisonCPT 99496 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address high-level medical decision-making, often including multiple diagnoses or prescription management.
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
| Key Fact | Detail |
|---|---|
| Service Type | Evaluation and Management Transitional Care Management Services |
| Common Place of Service | 11 - Office 99 - Other POS |
| Common Modifiers | 25 - Significant, separately identifiable E/M service same day 95 - Telemedicine - audio and video |
| Complexity Level | High |
| Medicare Fee Schedule | $298.60 national non-facility rate (2026) · View Medicare rates for 99496 |
| Medicaid Fee Schedule | $235.185 median of the 8 states in the free preview · View Medicaid rates for 99496 |
National average reimbursement for CPT 99496 by major payers:
$291.98
$303.80
$300.75
$409.03
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 99496.
CPT 99496
5 of 25 sample ratesHigher to lower in this preview
Greta Brodsky
Abksw Preferred Health Partners
$476.82Published rateMary Ann Rodriguez
Scott & White Clinic
$340.92Published rateBasanti Vrushab
Basanti Vrushab Md PLLC
$210.75Published rateMiguel Quinones
Houston Community Health Centers Inc
$185.41Published rateAmanuel Abreha
Liberty County Hospital District
$128.96Published rate
Get a free rate benchmark for your specialty.
Choose your state and specialty to build a report from payer-published rates.
Use market rates to prepare your payer proposal.
Payer Contract Negotiation
Draft a fee schedule renegotiation letter.
Use your fee schedule and market benchmarks to set target rates and draft a letter for your payer.
See a sample payer proposalCPT 99496 vs. Other Transitional Care Management Services Codes
The CPT 99496 code is part of the Evaluation and Management services used for Transitional Care Management Services. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 99496 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 99495-CPT | Moderate | Care Management, Assessment Of And Care Planning For A Patient With Cognitive Impairment Requiring An Independent Historian In The Office Or Other Outpatient Home Or Domiciliary Or Rest Home With All Of The Following Required Elements: Cognition-Focused Evaluation Including A Pertinent History And Examination Medical Decision Making Of Moderate Or High Complexity Functional Assessment (Eg Basic And Instrumental Activities Of Daily Living) Including Decision-Making Capacity Use Of Standardized |
| 99496-CPT | High | 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 |
| 99497-CPT | Low | Advncd 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 |
| 99498-CPT | Low | Advncd 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 |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 99496. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99496 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
FREE SAMPLE MARKET COMPARISON
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 99496) and we'll show you how you compare in 15 minutes or less.
Frequently Asked Questions
CPT code 99496 is used for Transitional Care Management (TCM) services that require a high level of medical decision-making. Key components of this service include communication with the patient and/or their caregiver within two business days following discharge, and a mandatory face-to-face visit with the patient within seven calendar days of discharge.