CPT code 99496: Transitional care management, high complexity, visit within 7 days2026 Medicare rate & RVUs

Medicare pays $298.60 for 99496 nationally in the office and $166.34 in a hospital or facility. Local office rates run $271.59–$381.30.

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

What 99496 covers

Transitional care management follows discharge from a hospital inpatient stay, hospital observation, skilled nursing facility, or other qualifying facility to home or another community setting. A physician or qualified health care professional, often a primary care clinician or specialist, coordinates care for 30 days beginning on discharge. The practitioner or clinical staff contacts the patient or caregiver within 2 business days, and the practitioner conducts a face-to-face visit within 7 calendar days. Non-face-to-face work includes reviewing discharge records, following up on tests, reconciling medications, and arranging home services.

Report one 99496 per 30-day period when medical decision making is high complexity and the visit is timely; only one practitioner can bill transitional care management for that patient and period. The first face-to-face visit is included; medically necessary later visits may be billed separately. Document discharge and visit dates, contact or at least two timely unsuccessful attempts, medication reconciliation by the visit, and high-complexity decision making. Use the face-to-face visit date as the date of service; CMS permits claim submission once that visit is furnished.

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.

Where 99496 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

99496 rates by state

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

How the 99496 rate is calculated

Each of 99496’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 99496

99496 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.

99496 compared with similar codes

How to choose

99495Transitional care managementModerate complexity, visit within 14 days

99495 requires at least moderate-complexity decision making and a visit within 14 days; 99496 requires high-complexity decision making and a visit within 7 days.

99215Office visitEstablished patient, high complexity

99215 covers an established-patient office visit selected by medical decision making or qualifying time. 99496 covers a 30-day post-discharge period requiring timely contact, high-complexity decision making, and a visit within 7 days.

99491Chronic care management30 minutes, physician/QHP time

99491 is practitioner-provided, time-based monthly management of multiple chronic conditions. 99496 begins with a qualifying discharge and requires timely contact and a face-to-face visit.

99487Complex chronic care managementClinical staff, first 60 minutes

99487 measures complex chronic care management by clinical staff time per month. 99496 is a discharge-triggered, 30-day service with a required face-to-face visit.

Codes related to 99496

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

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