# CPT 99496: Transitional care management services, high complexity medical decision making

Medicare CPT 99496 pays $298.60 in a non-facility setting and $166.34 in a facility setting under the 2026 Medicare Physician Fee Schedule, before geographic adjustment. After geographic adjustment, state amounts run from $271.59 in Arkansas to $368.96 in Alaska, a 36% spread.

Web page: https://www.med-reveal.com/rates/99496-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 | $298.60 |
| National facility | $166.34 |
| Conversion factor | 33.4009 |
| Release | 2026 Q4 (effective 2026-10-01) |

## By state

| State | Non-facility | Facility |
| --- | --- | --- |
| Alaska | $368.96 | $228.09 |
| District of Columbia | $335.54 | $179.73 |
| California | $329.53 | $173.02 |
| New Jersey | $326.45 | $177.52 |
| New York | $326.44 | $178.89 |
| Washington | $323.86 | $173.08 |
| Massachusetts | $321.21 | $172.61 |
| Hawaii | $317.70 | $167.31 |
| Connecticut | $315.45 | $172.99 |
| Colorado | $308.86 | $168.13 |
| Maryland | $307.84 | $169.96 |
| Florida | $306.74 | $174.03 |
| Oregon | $306.17 | $166.83 |
| Rhode Island | $305.56 | $168.92 |
| New Hampshire | $304.33 | $166.64 |
| Illinois | $300.82 | $173.01 |
| Puerto Rico | $300.29 | $166.57 |
| Virgin Islands | $300.29 | $166.57 |
| Montana | $298.59 | $166.32 |
| Minnesota | $297.72 | $161.61 |
| Nevada | $297.43 | $165.03 |
| Pennsylvania | $296.94 | $167.38 |
| Wyoming | $296.52 | $164.25 |
| Delaware | $296.46 | $165.78 |
| Texas | $296.19 | $165.97 |
| North Dakota | $293.84 | $161.57 |
| Virginia | $293.46 | $163.44 |
| South Dakota | $293.28 | $161.01 |
| Vermont | $293.00 | $162.06 |
| Georgia | $292.83 | $166.65 |
| Arizona | $292.37 | $164.20 |
| Michigan | $291.87 | $167.67 |
| Maine | $288.31 | $161.93 |
| Utah | $287.95 | $163.61 |
| New Mexico | $286.60 | $165.31 |
| Wisconsin | $286.17 | $159.46 |
| Missouri | $284.98 | $163.60 |
| South Carolina | $284.94 | $162.72 |
| Louisiana | $284.72 | $163.95 |
| North Carolina | $284.72 | $161.32 |
| Ohio | $284.40 | $163.64 |
| Indiana | $282.51 | $159.90 |
| Idaho | $281.26 | $159.57 |
| Nebraska | $280.99 | $158.91 |
| West Virginia | $280.58 | $165.63 |
| Tennessee | $279.97 | $159.74 |
| Iowa | $279.83 | $158.81 |
| Kentucky | $279.72 | $162.13 |
| Oklahoma | $279.27 | $161.15 |
| Kansas | $278.88 | $159.31 |
| Alabama | $274.63 | $158.89 |
| Mississippi | $273.72 | $159.83 |
| Arkansas | $271.59 | $157.97 |

## 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 99496 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