CPT code 99495: Transitional care management, moderate complexity, visit within 14 days2026 Medicare rate & RVUs in Puerto Rico

In Puerto Rico, Medicare pays $221.35 for 99495 in the office and $122.41 when it’s performed in a hospital or facility.

Check a contract rate as a % of Medicare · 99495 nationwide

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

What 99495 covers

This service covers a practitioner's management of a patient returning to a community setting after an inpatient hospital stay, observation, skilled nursing facility stay, inpatient rehabilitation, or partial hospitalization. The 30-day period begins on the discharge date. The practice must make interactive contact with the patient or caregiver within two business days. A face-to-face visit must occur within 14 calendar days; medication reconciliation must occur by that visit. Other work may include reviewing discharge records, following up on pending tests, arranging referrals, and educating the family. Primary care physicians, NPs, and PAs commonly report the service, with clinical staff helping with outreach.

Select 99495 when medical decision making is at least moderate and the visit occurs within 14 calendar days; high-complexity decision making with a visit within seven days instead meets the timing and complexity criteria for 99496. Document the discharge date, timely contact or contact attempts, visit date, medication reconciliation, and decision making. Only one practitioner reports transitional care management for a patient's 30-day period, once per period. The required face-to-face visit is included rather than billed as a separate E/M visit.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

How Puerto Rico compares for 99495

Across 109 of 109 payment localities, the office rate for 99495 runs from $199.99 in Arkansas to $280.82 in San Benito County, CA. Puerto Rico pays $221.35. The RVUs are the same everywhere; the geographic indexes change the dollars.

Every other payment area

99495 rates by state

Office rate range in each state. Select a state to see its payment localities.

See 99495 in every payment locality

How the 99495 rate is calculated

Each of 99495’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

Payment rules and modifiers for 99495

99495 has no global surgery period, no multiple-procedure, bilateral or assistant-at-surgery adjustment, and no professional/technical split. What changes the payment is where the service happens: the place of service on the claim decides whether Medicare pays the office or the facility rate.

Codes related to 99495

Related codes aren’t interchangeable: bill the code that matches the service performed.

How 99495 has changed in Puerto Rico

Price 99495 for an earlier date of service

Where the Puerto Rico rate applies

Puerto Rico is a Medicare payment area, not a city. Our Census mapping connects it to 292 cities and communities in Puerto Rico. Some span more than one payment area; confirm with the service ZIP.

• Aceitunas
• Adjuntas
• Aguada
• Aguadilla
• Aguas Buenas
• Aguas Claras
• Aguilita
• Aibonito

Browse all communities in Puerto Rico

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Open CMS sourceHow we calculate rates