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New York rates for HCPCS 99496

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, High level of medical decision making during the service period, Face-to-face visit, within 7 calendar days of discharge

Facilitymedian $219 · 10th–90th $117–$5130%10%20%10th90th$219Professionalmedian $234 · 10th–90th $151–$5130%10%10th90th$234$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
$117.49 / $218.78 / $512.86
Aetna
Facility/Professional
Facility
Modifier
25
Typical Low / Median / Typical High
$331.13 / $331.13 / $524.81
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$147.91 / $234.42 / $501.19
Aetna
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$245.47 / $316.23 / $707.95
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$190.55 / $239.88 / $309.03
Ambetter
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$239.88 / $251.19 / $309.03
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$154.88 / $194.98 / $457.09
CDPHP
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$275.42 / $275.42 / $275.42
CDPHP
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$275.42 / $275.42 / $389.05
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$295.12 / $295.12 / $53,703.18
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$173.78 / $309.03 / $660.69
Emblem Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$93.33 / $186.21 / $416.87
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$257.04 / $457.09 / $660.69
Excellus BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$154.88 / $263.03 / $263.03
Excellus BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$169.82 / $295.12 / $489.78
Highmark BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$275.42 / $407.38 / $707.95
Highmark BCBS
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$275.42 / $478.63 / $676.08
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
$263.03 / $338.84 / $446.68
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$239.88 / $323.59 / $645.65
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$131.83 / $245.47 / $524.81
Univera
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$77.62 / $181.97 / $323.59
Univera
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$100.00 / $295.12 / $478.63