Billing code 99495: Transitional care managementMedicare rate & RVUs in Delaware
Report transitional care management after a qualifying discharge when timely contact, at least moderate-complexity decision making, and a visit within 14 days are documented.
Medicare pays $218.48 for 99495 in the office in Delaware (Delaware). 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 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.
99495 in Delaware
| Payment locality | Office | Facility |
|---|---|---|
| Delaware | $218.48 | $121.79 |
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.
How the rate is built · 99495
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 2.78Practice expense 3.62Malpractice 0.19
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
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.
Place of service · 99495
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
Non-facility (office) rate · national
$220.11
The facility rate would be $122.25 (+$97.86). In a facility, the facility bills its own costs separately.
99495 compared with similar codes
Compare codes
99495 vs 99496 vs 99214 vs 99238 vs 99490: national Medicare rates
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How to choose
- 99496Transitional care management
- 99496 requires both high-complexity decision making and a visit within seven days. 99495 covers moderate-complexity decision making with a visit within 14 days, or high-complexity decision making when the visit occurs on days 8 through 14.
- 99214Office visit
- A post-discharge office visit may be reported with 99214 when transitional care requirements are unmet and the visit supports that E/M level. 99495 requires timely contact, at least moderate-complexity decision making, and a visit within 14 days.
- 99238Hospital discharge
- 99238 covers discharge day management in the facility. 99495 covers transitional care after discharge, and its required face-to-face visit cannot occur on the discharge service date.
- 99490Chronic care management
- 99490 is monthly clinical staff time for ongoing chronic care management. 99495 is discharge-triggered transitional care tied to a contact deadline and a face-to-face visit deadline.
99495 billing questions
How do I choose between 99495 and 99496?
99496 requires high-complexity decision making and a face-to-face visit within seven calendar days of discharge. Report 99495 for moderate-complexity decision making with a visit within 14 days, or high-complexity decision making with a visit on days 8 through 14.
Can I bill the face-to-face visit separately as an office visit?
No. The required face-to-face visit is included in 99495. Additional medically necessary E/M visits later in the 30-day period may be reported separately.
What if the two-business-day contact was not successful?
CMS accepts two or more separately documented, unsuccessful contact attempts within the two business days. Continue trying to reach the patient or caregiver; if the remaining requirements are met, the service may still be reported.
What date of service should go on the claim, and when can it be submitted?
Use the date of the face-to-face visit as the date of service. CMS allows submission once that visit has been furnished, without waiting for the 30-day period to end.
Can the face-to-face visit be done by telehealth?
Yes. The required visit can be furnished by telehealth when Medicare telehealth billing requirements are met.
Can the discharging physician also bill 99495?
Yes. A physician who reports discharge day management may also report transitional care management, but the required face-to-face visit cannot occur on the discharge service date.
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
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