Transitional care management services for problem of at least moderate complexity
Medicare pricing data for 94,125 providers across 52 states
Prices vary significantly by location — from $107 in Maine to $230 in Alaska. Where you get this procedure matters more than almost any other factor. Note: These costs reflect the Medicare physician/supplier component. Hospital facility fees are billed separately and can be 2-5x the physician fee.
💡 What You Should Know
Transitional care management services for problem of at least moderate complexity (HCPCS code 99495) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $178.07, but hospitals typically charge $386.20 — a 2.2x markup. Prices vary significantly by state and provider.
🏷️ Typical Out-of-Pocket Cost
Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $178.07, your out-of-pocket cost would be approximately $35.61. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.
What Hospitals Charge vs. What Medicare Pays
Hospitals charge 2.2x more than what Medicare allows for this procedure. Medicare actually pays $137.52 on average.
Cost by State
Medicare-allowed amounts vary significantly by state
| State | Allowed Cost | Hospital Charge | Providers | Services | vs. National |
|---|---|---|---|---|---|
| Alaska | $230 | $637 | 60 | 562 | +29.0% |
| District of Columbia | $207 | $439 | 154 | 643 | +16.2% |
| Connecticut | $206 | $438 | 1,383 | 8,160 | +15.5% |
| California | $205 | $419 | 5,398 | 38,271 | +15.2% |
| Puerto Rico | $203 | $667 | 8 | 33 | +14.2% |
| Maryland | $203 | $383 | 2,075 | 17,854 | +13.7% |
| New York | $194 | $447 | 5,405 | 35,791 | +8.9% |
| Illinois | $191 | $401 | 3,561 | 29,505 | +7.5% |
| New Jersey | $191 | $423 | 2,940 | 22,450 | +7.0% |
| Massachusetts | $190 | $526 | 2,971 | 21,004 | +6.6% |
| Nevada | $189 | $389 | 659 | 4,200 | +6.4% |
| Wyoming | $189 | $365 | 83 | 668 | +5.9% |
| Washington | $187 | $458 | 2,277 | 12,256 | +4.9% |
| Arizona | $186 | $347 | 1,785 | 12,075 | +4.4% |
| Florida | $185 | $376 | 7,219 | 64,949 | +3.8% |
| Georgia | $184 | $388 | 2,232 | 15,267 | +3.2% |
| Minnesota | $183 | $594 | 1,977 | 10,536 | +2.7% |
| Utah | $183 | $326 | 714 | 4,082 | +2.6% |
| Virginia | $183 | $337 | 2,454 | 22,102 | +2.6% |
| Alabama | $181 | $275 | 1,434 | 10,468 | +1.7% |
| Texas | $180 | $374 | 5,483 | 32,468 | +1.0% |
| South Carolina | $179 | $382 | 1,909 | 14,546 | +0.3% |
| Indiana | $179 | $355 | 2,264 | 15,235 | +0.2% |
| North Carolina | $177 | $378 | 4,299 | 25,190 | -0.4% |
| Louisiana | $176 | $339 | 1,153 | 8,812 | -1.3% |
| Pennsylvania | $175 | $356 | 5,923 | 53,701 | -1.7% |
| Tennessee | $174 | $357 | 2,256 | 14,658 | -2.3% |
| Wisconsin | $174 | $588 | 2,104 | 12,820 | -2.5% |
| Delaware | $173 | $339 | 467 | 6,128 | -2.9% |
| Iowa | $171 | $393 | 1,044 | 8,707 | -3.8% |
| New Mexico | $171 | $378 | 401 | 1,649 | -4.0% |
| Kentucky | $166 | $336 | 1,440 | 12,818 | -6.9% |
| Hawaii | $166 | $326 | 248 | 1,337 | -7.0% |
| Mississippi | $165 | $252 | 770 | 8,021 | -7.1% |
| Kansas | $162 | $329 | 907 | 9,030 | -9.1% |
| West Virginia | $159 | $359 | 703 | 5,903 | -10.5% |
| Missouri | $159 | $343 | 1,366 | 9,963 | -11.0% |
| Rhode Island | $157 | $408 | 330 | 1,626 | -11.8% |
| New Hampshire | $156 | $434 | 657 | 4,626 | -12.4% |
| Michigan | $156 | $315 | 4,009 | 21,312 | -12.6% |
| Colorado | $154 | $419 | 1,551 | 8,600 | -13.4% |
| Vermont | $152 | $239 | 161 | 798 | -14.5% |
| South Dakota | $150 | $329 | 262 | 2,151 | -15.8% |
| Arkansas | $150 | $269 | 890 | 8,555 | -16.0% |
| Nebraska | $148 | $428 | 686 | 5,653 | -17.0% |
| Ohio | $148 | $339 | 4,184 | 26,406 | -17.1% |
| Oregon | $147 | $519 | 1,247 | 6,786 | -17.2% |
| Idaho | $144 | $304 | 490 | 2,750 | -19.0% |
| Oklahoma | $143 | $323 | 943 | 7,841 | -19.4% |
| North Dakota | $122 | $276 | 245 | 1,715 | -31.3% |
| Montana | $122 | $369 | 381 | 3,536 | -31.3% |
| Maine | $107 | $341 | 539 | 2,291 | -39.7% |
⚠️ Important: These costs reflect the Medicare physician/supplier component. Hospital facility fees may be billed separately. Total out-of-pocket costs may be higher.
💊 Need post-procedure medications? Check costs on OpenPrescriber