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

In Delaware, Medicare pays $296.46 for 99496 in the office and $165.78 when it’s performed in a hospital or facility.

Check a contract rate as a % of Medicare · 99496 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 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.

How Delaware compares for 99496

Across 109 of 109 payment localities, the office rate for 99496 runs from $271.59 in Arkansas to $381.30 in San Benito County, CA. Delaware pays $296.46. The RVUs are the same everywhere; the geographic indexes change the dollars.

Every other payment area

99496 rates by state

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

See 99496 in every payment locality

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.

Codes related to 99496

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

How 99496 has changed in Delaware

Price 99496 for an earlier date of service

Where the Delaware rate applies

Delaware is a Medicare payment area, not a city. Our Census mapping connects it to 79 cities and communities in Delaware. Some span more than one payment area; confirm with the service ZIP.

• Arden
• Ardencroft
• Ardentown
• Bear
• Bellefonte
• Bethany Beach
• Bethel
• Blades

Browse all communities in Delaware

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