Cost analysis for CPT 99495 — Transitional care management services for problem of at least moderate complexity
Average Medicare Payment
$138.27
2023 data
Total Payments (2023)
$54.2M
Services (2023)
389.6K
Price Change (2014–2023)
+14.8%
| Year | Avg Payment | Total Payments | Services | YoY Change |
|---|---|---|---|---|
| 2014 | $120.47 | $23.7M | 196.1K | — |
| 2015 | $120.44 | $30.6M | 253.1K | -0.0% |
| 2016 | $118.75 | $39.4M | 331.2K | -1.4% |
| 2017 | $119.29 | $46.8M | 391.5K | +0.5% |
| 2018 | $119.75 | $54.5M | 454.0K | +0.4% |
| 2019 | $120.41 | $62.0M | 513.5K | +0.6% |
| 2020 | $136.17 | $47.2M | 345.6K | +13.1% |
| 2021 | $151.13 | $55.6M | 367.0K | +11.0% |
| 2022 | $141.05 | $50.7M | 356.2K | -6.7% |
| 2023 | $138.27 | $54.2M | 389.6K | -2.0% |
The most expensive state pays 2.5x more than the cheapest for this procedure. AK averages $181.85 vs ME at $73.45.
| State | Avg Payment | Total Payments | Services | Providers |
|---|---|---|---|---|
| AK | $181.85 | $75.8K | 417 | 18 |
| CT | $163.23 | $603.0K | 3.7K | 203 |
| CA | $159.15 | $3.5M | 22.0K | 898 |
| MD | $158.72 | $1.8M | 11.4K | 530 |
| NY | $157.52 | $3.0M | 19.0K | 774 |
| DC | $157.09 | $29.7K | 189 | 11 |
| IL | $152.42 | $2.9M | 18.9K | 806 |
| MA | $151.31 | $1.7M | 11.3K | 550 |
| NV | $149.28 | $338.3K | 2.3K | 110 |
| AZ | $147.57 | $1.0M | 6.9K | 289 |
| NJ | $147.42 | $1.9M | 13.1K | 587 |
| MN | $146.61 | $600.5K | 4.1K | 208 |
| WY | $146.23 | $63.0K | 431 | 21 |
| WA | $145.79 | $803.4K | 5.5K | 286 |
| GA | $145.26 | $1.3M | 9.0K | 415 |
| UT | $145.00 | $255.8K | 1.8K | 77 |
| AL | $143.93 | $866.0K | 6.0K | 272 |
| FL | $143.23 | $6.4M | 44.4K | 1.6K |
| VA | $143.10 | $2.1M | 14.9K | 599 |
| NC | $142.77 | $1.7M | 12.2K | 573 |
| NM | $142.64 | $96.0K | 673 | 38 |
| SC | $142.47 | $1.2M | 8.6K | 400 |
| LA | $140.76 | $788.0K | 5.6K | 227 |
| IN | $140.20 | $1.2M | 8.5K | 396 |
| TX | $140.11 | $2.3M | 16.5K | 748 |
| TN | $138.64 | $1.1M | 7.7K | 359 |
| PA | $135.52 | $4.8M | 35.3K | 1.6K |
| WI | $135.31 | $762.3K | 5.6K | 283 |
| IA | $134.35 | $749.7K | 5.6K | 252 |
| DE | $131.97 | $635.2K | 4.8K | 180 |
| MS | $130.86 | $773.9K | 5.9K | 231 |
| KY | $129.62 | $1.1M | 8.4K | 375 |
| WV | $125.46 | $476.3K | 3.8K | 160 |
| KS | $124.03 | $801.6K | 6.5K | 271 |
| NH | $122.96 | $280.2K | 2.3K | 118 |
| MI | $121.06 | $1.0M | 8.6K | 432 |
| VT | $120.73 | $36.2K | 300 | 18 |
| HI | $119.70 | $67.3K | 562 | 29 |
| SD | $118.80 | $157.3K | 1.3K | 64 |
| MO | $116.70 | $662.8K | 5.7K | 270 |
| RI | $116.43 | $72.0K | 618 | 37 |
| AR | $114.69 | $694.8K | 6.1K | 236 |
| ID | $109.36 | $131.9K | 1.2K | 59 |
| CO | $109.12 | $418.9K | 3.8K | 206 |
| OH | $108.59 | $1.3M | 12.3K | 620 |
| NE | $108.09 | $399.4K | 3.7K | 173 |
| OR | $107.00 | $298.1K | 2.8K | 151 |
| OK | $102.68 | $526.4K | 5.1K | 221 |
| ND | $81.11 | $79.8K | 984 | 46 |
| MT | $79.96 | $185.9K | 2.3K | 98 |
| ME | $73.45 | $50.2K | 684 | 36 |
| Provider | Specialty | State | Payments | Services | Avg/Service |
|---|---|---|---|---|---|
| Nancy Crain | Physician Assistant | FL | $113.8K | 871 | $130.63 |
| Carisa Hernandez | Nurse Practitioner | CA | $54.3K | 357 | $152.04 |
| Pedro Garcia | Internal Medicine | FL | $54.2K | 346 | $156.61 |
| Chang (Kenny) Chen | Nurse Practitioner | NY | $51.9K | 482 | $107.70 |
| Jean-Pierre Antaki | Infectious Disease | CA | $50.4K | 281 | $179.35 |
| Maureen Connolly | Nurse Practitioner | NY | $49.7K | 308 | $161.45 |
| Amy Ferrara | Nurse Practitioner | NY | $45.8K | 286 | $160.14 |
| Tracy Marmer | Physician Assistant | NY | $40.9K | 255 | $160.35 |
| Hong Liu | Internal Medicine | LA | $39.1K | 256 | $152.63 |
| Olga Freeman | Internal Medicine | FL | $37.0K | 229 | $161.77 |
| Hovik Abedi | Nurse Practitioner | CA | $36.9K | 243 | $151.98 |
| Suzanne Lee | Nurse Practitioner | NY | $36.5K | 231 | $158.16 |
| Russell Hines | Internal Medicine | CA | $35.0K | 199 | $175.98 |
| Talal Samaan | Hospitalist | CA | $32.6K | 198 | $164.48 |
| Salman Ahmad | Family Practice | TX | $30.7K | 200 | $153.45 |
| John Cappleman | Internal Medicine | FL | $29.9K | 191 | $156.57 |
| Atul Bhasin | Internal Medicine | NJ | $29.0K | 166 | $174.81 |
| Janelle Berridge | Nurse Practitioner | NY | $28.8K | 188 | $153.21 |
| Nibha Mediratta | Internal Medicine | FL | $27.8K | 182 | $152.82 |
| Dori Hunt | Nurse Practitioner | IL | $27.6K | 214 | $129.17 |
The data suggests significant pricing inconsistencies for CPT 99495. With a 2.5x price gap between the most and least expensive states, geography plays an outsized role in what Medicare pays for this procedure.
Costs have risen 14.8% since 2014, outpacing inflation and raising questions about whether reimbursement rates reflect actual costs.
This analysis is based on publicly available CMS data and does not account for patient complexity, comorbidities, or facility-specific factors that may justify pricing differences.
Note: All data is from publicly available Medicare records. OpenMedicare is an independent journalism project not affiliated with CMS.