Billing code 99496: Transitional care managementMedicare rate & RVUs in Alaska
Thirty-day post-discharge care management requiring high-complexity medical decision making, contact within 2 business days, and a face-to-face visit within 7 days.
Medicare pays $368.96 for 99496 in the office in Alaska (Alaska*). Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 9 sections
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.
99496 in Alaska*
| Payment locality | Office | Facility |
|---|---|---|
| Alaska* | $368.96 | $228.09 |
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.
How the rate is built · 99496
RVUs × geographic indexes × conversion factor
Work3.79
3.79 RVUs× 1.000 GPCI
Practice expense4.91
4.91 RVUs× 1.000 GPCI
Malpractice0.24
0.24 RVUs× 1.000 GPCI
Adjusted RVUs
8.9400
Conversion factor
$33.4009
Medicare rate
$298.60
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
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.
Place of service · 99496
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
POS 11 · non-facility rate · national
$298.60
- Non-facility (office)
- $298.60
- Facility
- $166.34
Higher because the practice carries its own overhead.
99496 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 99495Transitional care management
- 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 visit
- 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 management
- 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 management
- 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.
99496 billing questions
When should 99496 be used instead of 99495?
Use 99496 for high-complexity medical decision making and a face-to-face visit within 7 calendar days of discharge. Use 99495 for at least moderate-complexity decision making and a visit within 14 days, including a high-complexity visit on days 8 through 14, when the other requirements are met.
Can the face-to-face visit be billed separately as an office visit?
No. The first face-to-face visit is included in transitional care management. Medically necessary visits after that first visit during the 30-day period may be reported separately.
What if interactive contact within 2 business days could not be made?
The service may still be reported if at least two separate, timely unsuccessful contact attempts are documented and the other requirements are met. Continue efforts to reach the patient or caregiver.
Can the discharging physician also report transitional care management?
Yes. The practitioner who handled the discharge may report it, but the required face-to-face visit cannot be furnished on the same day as discharge day management.
Can chronic care management be billed during the same period?
CMS permits chronic care management, such as 99490 or 99491, during the transitional care management period when both services meet their requirements and time or work is not counted twice.
What if the patient is readmitted or dies before day 30?
Readmission alone does not automatically preclude 99496 if its requirements are met; only one practitioner may report transitional care management for the patient during the 30-day period. If the patient dies before the period ends, report separately billable services furnished rather than 99496.
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
Show the CMS file lines behind this rate
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