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Virginia 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 $166 · 10th–90th $110–$2950%10%10th90th$166Professionalmedian $170 · 10th–90th $110–$3630%10%10th90th$170$50.0$200.0$1.0K$5.0K

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
$117.49 / $199.53 / $295.12
Aetna
Facility/Professional
Facility
Modifier
25
Typical Low / Median / Typical High
$251.19 / $251.19 / $251.19
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$107.15 / $162.18 / $363.08
Aetna
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$194.98 / $239.88 / $416.87
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$131.83 / $199.53 / $295.12
CareFirst
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$120.23 / $131.83 / $186.21
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $194.98 / $295.12
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$112.20 / $190.55 / $288.40
Medcost
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$109.65 / $162.18 / $234.42
Medcost
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$120.23 / $120.23 / $120.23
Sentara
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$104.71 / $162.18 / $10,000.00
Sentara
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$151.36 / $218.78 / $10,000.00
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$234.42 / $309.03 / $812.83
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$104.71 / $181.97 / $316.23