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New York rates for HCPCS 99495

Transitional care management services with the following required elements: Communication (direct contact, telephone, electronic) with the patient and/or caregiver within 2 business days of discharge, At least moderate level of medical decision making during the service period, Face-to-face visit, within 14 calendar days of discharge

Facilitymedian $174 · 10th–90th $105–$5130%10%10th90th$174Professionalmedian $166 · 10th–90th $107–$3800%10%20%10th90th$166$20.0$100.0$500.0$2.0K$10.0K$50.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$104.71 / $169.82 / $389.05
Aetna
Facility/Professional
Facility
Modifier
25
Typical Low / Median / Typical High
$28.18 / $199.53 / $512.86
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$104.71 / $162.18 / $380.19
Aetna
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$165.96 / $239.88 / $549.54
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$177.83 / $204.17 / $346.74
Ambetter
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$204.17 / $204.17 / $204.17
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$114.82 / $147.91 / $323.59
CDPHP
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$204.17 / $204.17 / $204.17
CDPHP
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$204.17 / $204.17 / $288.40
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$213.80 / $213.80 / $53,703.18
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $223.87 / $489.78
Emblem Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$63.10 / $138.04 / $309.03
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$190.55 / $338.84 / $489.78
Excellus BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$114.82 / $194.98 / $194.98
Excellus BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $199.53 / $363.08
Highmark BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$229.09 / $416.87 / $501.19
Highmark BCBS
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$213.80 / $371.54 / $489.78
MVP Health Care
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$50,118.72 / $53,703.18 / $75,857.76
MVP Health Care
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$199.53 / $257.04 / $323.59
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$208.93 / $323.59 / $467.74
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$100.00 / $181.97 / $389.05
Univera
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$53.70 / $134.90 / $239.88
Univera
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $218.78 / $354.81