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Pennsylvania 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 $126–$1,2880%10%20%10th90th$219Professionalmedian $269 · 10th–90th $155–$5010%10%20%10th90th$269$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
$125.89 / $218.78 / $1,288.25
Aetna
Facility/Professional
Facility
Modifier
25
Typical Low / Median / Typical High
$162.18 / $162.18 / $162.18
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$151.36 / $263.03 / $489.78
Aetna
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$208.93 / $309.03 / $676.08
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$239.88 / $281.84 / $467.74
Ambetter
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$239.88 / $239.88 / $426.58
AmeriHealth
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$295.12 / $295.12 / $316.23
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
$245.47 / $288.40 / $467.74
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$186.21 / $269.15 / $407.38
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$501.19 / $501.19 / $501.19
Geisinger
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$213.80 / $245.47 / $478.63
Highmark BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$251.19 / $588.84 / $741.31
Highmark BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$251.19 / $288.40 / $346.74
Highmark BCBS
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$234.42 / $263.03 / $309.03
Independence Blue Cross
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$295.12 / $295.12 / $316.23
Martin's Point
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$151.36 / $162.18 / $229.09
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$151.36 / $218.78 / $398.11
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 / $186.21 / $1,148.15
UPMC Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$48.98 / $186.21 / $1,148.15
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
$162.18 / $251.19 / $380.19