CMS RVU26D · Effective 2026-10-01
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. Compare 99495 office and facility rates across CMS payment localities in Pennsylvania.
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.
Pennsylvania has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
$209.85–$227.97
2 of 2 localities have a supported rate.
$120.01–$126.09
2 of 2 localities have a supported rate.
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
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.
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.
723.7K
Medicare services in 2024 · #182 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.
Office rates for Pennsylvania, from the same CMS release.
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.
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.
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.
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.
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.
2 of 2 payment localities
Office / nonfacility
$227.97
Facility
$126.09
Office / nonfacility
$209.85
Facility
$120.01
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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.
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.
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.
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.
Yes. The required visit can be furnished by telehealth when Medicare telehealth billing requirements are met.
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.
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.
