Transitional care management services for problem of high complexity
Medicare pricing data for 79,103 providers across 52 states
Prices vary significantly by location — from $145 in Maine to $295 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 high complexity (HCPCS code 99496) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $244.92, but hospitals typically charge $486.61 — a 2.0x 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 $244.92, your out-of-pocket cost would be approximately $48.98. 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 2.0x more than what Medicare allows for this procedure. Medicare actually pays $190.99 on average.
Cost by State
Medicare-allowed amounts vary significantly by state
| State | Allowed Cost | Hospital Charge | Providers | Services | vs. National |
|---|---|---|---|---|---|
| Alaska | $295 | $763 | 56 | 350 | +20.3% |
| District of Columbia | $282 | $560 | 165 | 1,152 | +15.1% |
| Puerto Rico | $278 | $530 | 8 | 80 | +13.4% |
| Connecticut | $277 | $575 | 1,266 | 8,541 | +13.1% |
| New York | $276 | $559 | 4,497 | 33,228 | +12.6% |
| California | $273 | $516 | 5,276 | 60,483 | +11.6% |
| Maryland | $273 | $479 | 1,968 | 21,617 | +11.5% |
| New Jersey | $263 | $509 | 2,649 | 25,643 | +7.2% |
| Illinois | $262 | $506 | 2,861 | 22,458 | +7.1% |
| Massachusetts | $259 | $704 | 2,343 | 20,192 | +5.8% |
| Delaware | $253 | $402 | 332 | 4,023 | +3.4% |
| Wyoming | $252 | $415 | 68 | 339 | +2.7% |
| Utah | $251 | $380 | 531 | 3,504 | +2.4% |
| Washington | $250 | $592 | 1,759 | 9,023 | +1.9% |
| Florida | $249 | $477 | 6,793 | 90,157 | +1.5% |
| Nevada | $247 | $474 | 586 | 6,614 | +0.9% |
| Hawaii | $246 | $439 | 220 | 1,302 | +0.6% |
| Virginia | $244 | $448 | 2,207 | 20,967 | -0.3% |
| Georgia | $244 | $503 | 1,904 | 14,631 | -0.4% |
| Arizona | $243 | $438 | 1,683 | 14,576 | -0.9% |
| Texas | $242 | $467 | 5,060 | 44,246 | -1.1% |
| Alabama | $242 | $366 | 1,321 | 11,396 | -1.1% |
| Indiana | $242 | $461 | 1,971 | 13,093 | -1.2% |
| South Carolina | $241 | $483 | 1,577 | 12,233 | -1.4% |
| North Carolina | $241 | $468 | 3,302 | 22,039 | -1.5% |
| Iowa | $238 | $515 | 702 | 4,621 | -3.0% |
| New Mexico | $236 | $476 | 338 | 1,935 | -3.6% |
| Pennsylvania | $235 | $452 | 4,255 | 35,226 | -3.9% |
| Louisiana | $234 | $447 | 1,047 | 8,803 | -4.5% |
| Vermont | $233 | $362 | 139 | 688 | -4.9% |
| Tennessee | $232 | $455 | 2,086 | 15,881 | -5.2% |
| Wisconsin | $232 | $764 | 1,515 | 8,644 | -5.2% |
| Minnesota | $228 | $568 | 959 | 3,888 | -6.9% |
| Missouri | $226 | $467 | 1,013 | 6,103 | -7.7% |
| New Hampshire | $226 | $550 | 470 | 2,770 | -7.9% |
| West Virginia | $220 | $448 | 553 | 3,725 | -10.3% |
| Kentucky | $220 | $434 | 1,095 | 7,770 | -10.3% |
| Michigan | $220 | $415 | 3,597 | 24,538 | -10.3% |
| Mississippi | $219 | $319 | 635 | 12,063 | -10.7% |
| Kansas | $214 | $433 | 632 | 4,134 | -12.8% |
| Ohio | $213 | $446 | 3,452 | 20,501 | -13.2% |
| Rhode Island | $212 | $519 | 298 | 1,798 | -13.5% |
| Colorado | $212 | $504 | 1,264 | 5,785 | -13.5% |
| Oregon | $208 | $674 | 955 | 4,858 | -15.1% |
| Idaho | $208 | $433 | 427 | 2,238 | -15.1% |
| Arkansas | $208 | $371 | 813 | 8,456 | -15.2% |
| South Dakota | $204 | $469 | 152 | 923 | -16.7% |
| Oklahoma | $198 | $421 | 792 | 6,877 | -19.1% |
| Montana | $189 | $511 | 294 | 1,835 | -22.8% |
| Nebraska | $188 | $509 | 562 | 5,244 | -23.3% |
| North Dakota | $157 | $374 | 200 | 1,175 | -35.9% |
| Maine | $145 | $423 | 426 | 1,471 | -41.0% |
⚠️ 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