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Data Sources: Centers for Medicare & Medicaid Services (CMS), Medicare Provider Utilization and Payment Data
Disclaimer: This site is an independent journalism project. Data analysis and editorial content are not affiliated with or endorsed by CMS or any government agency. All spending figures are based on publicly available Medicare payment records.
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Methodology•Download Data
  1. Home
  2. Procedures
  3. 99495
  4. Cost Analysis

How Much Does Transitional care management services for problem of at least moderate complexity Cost on Medicare?

Cost analysis for CPT 99495 — Transitional care management services for problem of at least moderate complexity

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Average Medicare Payment

$138.27

2023 data

Total Payments (2023)

$54.2M

Services (2023)

389.6K

Price Change (2014–2023)

+14.8%

📈 Year-over-Year Cost Trend

YearAvg PaymentTotal PaymentsServicesYoY Change
2014$120.47$23.7M196.1K—
2015$120.44$30.6M253.1K-0.0%
2016$118.75$39.4M331.2K-1.4%
2017$119.29$46.8M391.5K+0.5%
2018$119.75$54.5M454.0K+0.4%
2019$120.41$62.0M513.5K+0.6%
2020$136.17$47.2M345.6K+13.1%
2021$151.13$55.6M367.0K+11.0%
2022$141.05$50.7M356.2K-6.7%
2023$138.27$54.2M389.6K-2.0%

🗺️ State-by-State Cost Variation

The most expensive state pays 2.5x more than the cheapest for this procedure. AK averages $181.85 vs ME at $73.45.

StateAvg PaymentTotal PaymentsServicesProviders
AK$181.85$75.8K41718
CT$163.23$603.0K3.7K203
CA$159.15$3.5M22.0K898
MD$158.72$1.8M11.4K530
NY$157.52$3.0M19.0K774
DC$157.09$29.7K18911
IL$152.42$2.9M18.9K806
MA$151.31$1.7M11.3K550
NV$149.28$338.3K2.3K110
AZ$147.57$1.0M6.9K289
NJ$147.42$1.9M13.1K587
MN$146.61$600.5K4.1K208
WY$146.23$63.0K43121
WA$145.79$803.4K5.5K286
GA$145.26$1.3M9.0K415
UT$145.00$255.8K1.8K77
AL$143.93$866.0K6.0K272
FL$143.23$6.4M44.4K1.6K
VA$143.10$2.1M14.9K599
NC$142.77$1.7M12.2K573
NM$142.64$96.0K67338
SC$142.47$1.2M8.6K400
LA$140.76$788.0K5.6K227
IN$140.20$1.2M8.5K396
TX$140.11$2.3M16.5K748
TN$138.64$1.1M7.7K359
PA$135.52$4.8M35.3K1.6K
WI$135.31$762.3K5.6K283
IA$134.35$749.7K5.6K252
DE$131.97$635.2K4.8K180
MS$130.86$773.9K5.9K231
KY$129.62$1.1M8.4K375
WV$125.46$476.3K3.8K160
KS$124.03$801.6K6.5K271
NH$122.96$280.2K2.3K118
MI$121.06$1.0M8.6K432
VT$120.73$36.2K30018
HI$119.70$67.3K56229
SD$118.80$157.3K1.3K64
MO$116.70$662.8K5.7K270
RI$116.43$72.0K61837
AR$114.69$694.8K6.1K236
ID$109.36$131.9K1.2K59
CO$109.12$418.9K3.8K206
OH$108.59$1.3M12.3K620
NE$108.09$399.4K3.7K173
OR$107.00$298.1K2.8K151
OK$102.68$526.4K5.1K221
ND$81.11$79.8K98446
MT$79.96$185.9K2.3K98
ME$73.45$50.2K68436

💰 Who Bills the Most for This Procedure?

ProviderSpecialtyStatePaymentsServicesAvg/Service
Nancy CrainPhysician AssistantFL$113.8K871$130.63
Carisa HernandezNurse PractitionerCA$54.3K357$152.04
Pedro GarciaInternal MedicineFL$54.2K346$156.61
Chang (Kenny) ChenNurse PractitionerNY$51.9K482$107.70
Jean-Pierre AntakiInfectious DiseaseCA$50.4K281$179.35
Maureen ConnollyNurse PractitionerNY$49.7K308$161.45
Amy FerraraNurse PractitionerNY$45.8K286$160.14
Tracy MarmerPhysician AssistantNY$40.9K255$160.35
Hong LiuInternal MedicineLA$39.1K256$152.63
Olga FreemanInternal MedicineFL$37.0K229$161.77
Hovik AbediNurse PractitionerCA$36.9K243$151.98
Suzanne LeeNurse PractitionerNY$36.5K231$158.16
Russell HinesInternal MedicineCA$35.0K199$175.98
Talal SamaanHospitalistCA$32.6K198$164.48
Salman AhmadFamily PracticeTX$30.7K200$153.45
John CapplemanInternal MedicineFL$29.9K191$156.57
Atul BhasinInternal MedicineNJ$29.0K166$174.81
Janelle BerridgeNurse PractitionerNY$28.8K188$153.21
Nibha MedirattaInternal MedicineFL$27.8K182$152.82
Dori HuntNurse PractitionerIL$27.6K214$129.17

🤔 Is Transitional care management services for problem of at least moderate complexity Overpriced?

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.

Data Sources

  • • Centers for Medicare & Medicaid Services (CMS)
  • • Medicare Provider Utilization and Payment Data (2014-2023)
  • • Medicare Physician Fee Schedule

Note: All data is from publicly available Medicare records. OpenMedicare is an independent journalism project not affiliated with CMS.