#2274 of 11K

99496

Transitional care management, moderate complexity face-to-face visit

Transitional care management, moderate complexity face-to-face visit is the #2,274 most-billed Medicaid procedure code, with $7.2M in payments across 108K claims from 2018–2024. The national median cost per claim is $54.66. Costs vary widely — the 90th percentile is $147.95 per claim, 2.7× the median.

Total Paid

$7.2M

0.00% of all spending

Total Claims

108K

Providers

572

Avg Cost/Claim

$67

National Cost Distribution

How much do providers bill per claim for 99496? Based on 459 providers billing this code nationally.

Median

$54.66

Average

$68.21

Std Dev

$61.67

Max

$458.50

Percentile Distribution (Cost per Claim)

p10

$3.25

p25

$15.77

Median

$54.66

p75

$109.35

p90

$147.95

p95

$177.04

p99

$247.34

50% of providers bill between $15.77 and $109.35 per claim for this code.

90% bill between $3.25 and $147.95.

Top 1% bill above $247.34.

About This Procedure

HCPCS code 99496 (Transitional care management, moderate complexity face-to-face visit) was billed by 572 providers across 108K claims, totaling $7.2M in Medicaid payments from 2018–2024. This code was used for 92K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$54.66

Providers Billing

459

National Spending

$7.2M

Avg/Median Ratio

1.25×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for 99496

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1083952857	$1.1M	$275.46	5.0× median	Top 1%
2	1578076501	$930K	$273.51	5.0× median	Top 1%
3	1902232168	$406K	$138.17	2.5× median	Above 75th
4	1831248236	$386K	$234.27	4.3× median	Top 10%
5	1003829441	$300K	$106.61	2.0× median	Above Median
6	1619923919	$209K	$74.30	1.4× median	Above Median
7	William Beaumont Hospital Royal Oak, MI · Internal Medicine, Cardiovascular Disease	$189K	$141.97	2.6× median	Above 75th
8	1639210602	$138K	$137.71	2.5× median	Above 75th
9	1578595971	$127K	$102.96	1.9× median	Above Median
10	1669567806	$122K	$127.55	2.3× median	Above 75th
11	1578598868	$109K	$76.31	1.4× median	Above Median
12	1003398470	$102K	$118.96	2.2× median	Above 75th
13	1073040556	$88K	$37.11	0.7× median	Below Median
14	1295023547	$80K	$108.91	2.0× median	Above Median
15	1932457546	$76K	$150.76	2.8× median	Top 10%
16	The General Hospital Corporation Boston, MA · General Acute Care Hospital	$71K	$92.74	1.7× median	Above Median
17	Spectrum Health Primary Care Partners Grand Rapids, MI · Psychologist, Clinical Child & Adolescent	$67K	$131.10	2.4× median	Above 75th
18	1134175060	$60K	$99.75	1.8× median	Above Median
19	1811226749	$60K	$136.18	2.5× median	Above 75th
20	1407409253	$54K	$47.86	0.9× median	Below Median

Showing top 20 of 572 providers billing this code

Related Procedures

99490Chronic care management services, 20 minutes per month$315.0M 99499Unlisted evaluation and management service$176.4M 99497$34.2M 99493$11.3M 99487$9.3M

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