$206.85
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.
On this page
CMS RVU26D · Effective 2026-10-01
99496 Transitional care management Medicare reimbursement rates in Nebraska
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. Compare 99496 office and facility rates across CMS payment localities in Nebraska.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 99496 in Nebraska?
Nebraska has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
$280.99
1 of 1 localities have a supported rate.
Payment area: Nebraska
One mapped payment locality.
Facility setting
$158.91
1 of 1 localities have a supported rate.
Payment area: Nebraska
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Care management
About 99496: Transitional care management, high complexity, 7-day visit
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.
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.
Where the value comes from
- Work RVU3.79 · 42%
- Practice expense (office) RVU4.91 · 55%
- Malpractice RVU0.24 · 3%
697.4K
Medicare services in 2024 · #185 by national volume
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 compared with similar codes
Office rates for Nebraska, from the same CMS release.
$180.95
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.
$84.53
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.
$135.47
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.
Compare 99496 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Nebraska →
Office / nonfacility
$280.99
Facility
$158.91
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 99496 in Nebraska.
PPRRVU2026_Oct_nonQPP.csv
13,160
- Code
- 99496
- Physician work
- 3.79
- Practice expense
- 4.91
- Malpractice
- 0.24
GPCI2026.csv
72
- Locality
- Nebraska
- Physician work
- 1.000
- Practice expense
- 0.923
- Malpractice
- 0.378
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 3.79 | × 1.000 | 3.7900 |
| Practice expense | 4.91 | × 0.923 | 4.5319 |
| Malpractice | 0.24 | × 0.378 | 0.0907 |
| Total RVUs | 8.4126 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Nebraska$280.99
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 3.79 | 1 |
| Practice expense | 4.91 | 0.923 |
| Malpractice | 0.24 | 0.378 |
(3.79 × 1 + 4.91 × 0.923 + 0.24 × 0.378) × $33.4009 = $280.99
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 3.79 | 1 |
| Practice expense | 0.95 | 0.923 |
| Malpractice | 0.24 | 0.378 |
(3.79 × 1 + 0.95 × 0.923 + 0.24 × 0.378) × $33.4009 = $158.91
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
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 indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
13,15799493,,Sbsq psyc collab care mgmt,A,,2.05,2.15,,0.49,,0.14,4.34,2.68,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,15899494,,1st/sbsq psyc collab care,A,,0.82,0.96,,0.20,,0.06,1.84,1.08,0,ZZZ,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,15999495,,Transj care mgmt mod f2f 14d,A,,2.78,3.62,,0.69,,0.19,6.59,3.66,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,16099496,,Transj care mgmt high f2f 7d,A,,3.79,4.91,,0.95,,0.24,8.94,4.98,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,16199497,,Advncd care plan 30 min,A,,1.50,1.01,,0.38,,0.09,2.60,1.97,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,16299498,,Advncd care plan addl 30 min,A,,1.40,0.85,,0.41,,0.09,2.34,1.90,0,ZZZ,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,16399499,,Unlisted e&m service,C,,0.00,0.00,,0.00,,0.00,0.00,0.00,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6905302,MO,01,METROPOLITAN ST. LOUIS,1.000,0.952,1.002
7005302,MO,99,REST OF MISSOURI,1.000,0.862,0.974
7103202,MT,01,MONTANA**,1.000,1.000,0.998
7205402,NE,00,NEBRASKA,1.000,0.923,0.378
7301312,NV,00,NEVADA**,1.000,1.001,0.833
7414312,NH,40,NEW HAMPSHIRE,1.000,1.041,0.875
7512402,NJ,01,NORTHERN NJ,1.063,1.160,1.068