# CPT 99495: Transitional care management services, moderate complexity medical decision making

Medicare CPT 99495 pays $220.11 in a non-facility setting and $122.25 in a facility setting under the 2026 Medicare Physician Fee Schedule, before geographic adjustment. After geographic adjustment, state amounts run from $199.99 in Arkansas to $271.55 in Alaska, a 36% spread.

Web page: https://www.med-reveal.com/rates/99495-cpt-fee-schedule
Section: Evaluation and Management
Billed by: Child & Adolescent Psychiatry, Evaluation, Hematology & Oncology, Internal Medicine, Psychiatry & Neurology, Social Worker

## Medicare rates

| | Amount |
| --- | --- |
| National non-facility | $220.11 |
| National facility | $122.25 |
| Conversion factor | 33.4009 |
| Release | 2026 Q4 (effective 2026-10-01) |

## By state

| State | Non-facility | Facility |
| --- | --- | --- |
| Alaska | $271.55 | $167.32 |
| District of Columbia | $247.37 | $132.08 |
| California | $242.69 | $126.89 |
| New York | $240.77 | $131.59 |
| New Jersey | $240.66 | $130.46 |
| Washington | $238.63 | $127.06 |
| Massachusetts | $236.70 | $126.75 |
| Hawaii | $234.01 | $122.73 |
| Connecticut | $232.61 | $127.21 |
| Colorado | $227.57 | $123.45 |
| Maryland | $226.95 | $124.93 |
| Florida | $226.52 | $128.33 |
| Oregon | $225.57 | $122.47 |
| Rhode Island | $225.18 | $124.09 |
| New Hampshire | $224.28 | $122.40 |
| Illinois | $222.14 | $127.58 |
| Puerto Rico | $221.35 | $122.41 |
| Virgin Islands | $221.35 | $122.41 |
| Montana | $220.10 | $122.23 |
| Nevada | $219.17 | $121.21 |
| Minnesota | $219.15 | $118.45 |
| Pennsylvania | $218.91 | $123.05 |
| Delaware | $218.48 | $121.79 |
| Wyoming | $218.46 | $120.60 |
| Texas | $218.30 | $121.95 |
| North Dakota | $216.34 | $118.48 |
| Virginia | $216.19 | $119.99 |
| Georgia | $215.94 | $122.58 |
| South Dakota | $215.90 | $118.03 |
| Vermont | $215.77 | $118.88 |
| Arizona | $215.45 | $120.62 |
| Michigan | $215.32 | $123.43 |
| Maine | $212.36 | $118.85 |
| Utah | $212.21 | $120.22 |
| New Mexico | $211.35 | $121.61 |
| Wisconsin | $210.64 | $116.89 |
| Missouri | $210.06 | $120.25 |
| South Carolina | $209.97 | $119.54 |
| Louisiana | $209.89 | $120.54 |
| North Carolina | $209.72 | $118.41 |
| Ohio | $209.64 | $120.29 |
| Indiana | $208.02 | $117.30 |
| Idaho | $207.09 | $117.06 |
| West Virginia | $207.01 | $121.96 |
| Nebraska | $206.85 | $116.53 |
| Tennessee | $206.17 | $117.21 |
| Kentucky | $206.15 | $119.15 |
| Iowa | $206.01 | $116.46 |
| Oklahoma | $205.76 | $118.37 |
| Kansas | $205.36 | $116.89 |
| Alabama | $202.24 | $116.61 |
| Mississippi | $201.65 | $117.39 |
| Arkansas | $199.99 | $115.92 |

## Related codes

- 99424: Principal care management services, first 30 minutes per month, physician or QHP — https://www.med-reveal.com/rates/99424-cpt-fee-schedule
- 99425: Principal care management services, each additional 30 minutes per month, physician or QHP (add-on) — https://www.med-reveal.com/rates/99425-cpt-fee-schedule
- 99426: Principal care management services, first 30 minutes per month, clinical staff — https://www.med-reveal.com/rates/99426-cpt-fee-schedule
- 99427: Principal care management services, each additional 30 minutes per month, clinical staff (add-on) — https://www.med-reveal.com/rates/99427-cpt-fee-schedule
- 99439: Chronic care management services, non-complex, each additional 20 minutes per month (add-on) — https://www.med-reveal.com/rates/99439-cpt-fee-schedule
- 99484: General behavioral health integration care management, first 20 minutes per month — https://www.med-reveal.com/rates/99484-cpt-fee-schedule
- 99487: Complex chronic care management services, first 60 minutes per month — https://www.med-reveal.com/rates/99487-cpt-fee-schedule
- 99489: Complex chronic care management services, each additional 30 minutes per month (add-on) — https://www.med-reveal.com/rates/99489-cpt-fee-schedule

Commercial negotiated rates for 99495 by payer and state: https://www.med-reveal.com/solutions/rate-benchmarking

## Sources

- CMS Medicare fee schedules (2026 Q4): https://www.cms.gov/medicare/payment/fee-schedules