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Pennsylvania 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 $191 · 10th–90th $112–$5620%20%10th90th$191Professionalmedian $191 · 10th–90th $112–$3980%10%20%10th90th$191$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
$109.65 / $162.18 / $912.01
Aetna
Facility/Professional
Facility
Modifier
25
Typical Low / Median / Typical High
$169.82 / $512.86 / $562.34
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$109.65 / $177.83 / $380.19
Aetna
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$147.91 / $263.03 / $562.34
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$181.97 / $331.13 / $398.11
Ambetter
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$302.00 / $302.00 / $338.84
AmeriHealth
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$213.80 / $213.80 / $229.09
Capital Blue Cross
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5,011.87 / $8,511.38 / $77,624.71
Capital Blue Cross
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$181.97 / $213.80 / $346.74
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$131.83 / $194.98 / $302.00
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$371.54 / $371.54 / $371.54
Geisinger
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$158.49 / $181.97 / $354.81
Highmark BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$213.80 / $295.12 / $588.84
Highmark BCBS
Facility/Professional
Facility
Modifier
25
Typical Low / Median / Typical High
$524.81 / $616.60 / $741.31
Highmark BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$173.78 / $213.80 / $245.47
Highmark BCBS
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$173.78 / $213.80 / $263.03
Independence Blue Cross
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$194.98 / $213.80 / $229.09
Martin's Point
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$112.20 / $117.49 / $169.82
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$112.20 / $162.18 / $288.40
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$128.82 / $128.82 / $128.82
UPMC Health Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$48.98 / $120.23 / $199.53
UPMC Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$48.98 / $138.04 / $309.03
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$239.88 / $389.05 / $446.68
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$123.03 / $186.21 / $281.84