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Ohio 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 $224 · 10th–90th $56–$4070%10%10th90th$224Professionalmedian $245 · 10th–90th $148–$4570%5%10%10th90th$245$2.0$10.0$50.0$200.0$1.0K

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
$56.23 / $223.87 / $407.38
Aetna
Facility/Professional
Facility
Modifier
25
Typical Low / Median / Typical High
$23.99 / $208.93 / $489.78
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$147.91 / $239.88 / $467.74
Aetna
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$128.82 / $302.00 / $524.81
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$229.09 / $281.84 / $371.54
Ambetter
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$239.88 / $281.84 / $416.87
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$169.82 / $229.09 / $398.11
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$134.90 / $173.78 / $229.09
CareSource
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$208.93 / $263.03 / $549.54
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$208.93 / $208.93 / $234.42
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$158.49 / $263.03 / $416.87
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$154.88 / $154.88 / $154.88
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$158.49 / $257.04 / $426.58
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $33.11
SummaCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$162.18 / $162.18 / $162.18
SummaCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$173.78 / $295.12 / $426.58
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$269.15 / $316.23 / $467.74
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$147.91 / $239.88 / $380.19