Digital, remote monitoring & care management

99496 - RVUs & Medicare payment (2026)

Transitional care management, high complexity (7-day contact).

Component	Non-facility	Facility
Work RVU	3.79	3.79
Practice expense RVU	4.91	0.95
Malpractice RVU	0.24	0.24
Total RVUs	8.94	4.98
National payment (CF $33.4009)	$298.60	$166.34
Qualifying APM payment (CF $33.5675)	$300.09	$167.17

How 99496 payment varies by locality

Medicare adjusts payment with geographic practice cost indices, so the same code pays differently across the 109 fee schedule localities. In 2026, non-facility payment for 99496 ranges from $271.59 in Arkansas (AR) to $381.30 in San Jose-Sunnyvale-Santa Clara (CA); calculate 99496 for your locality.

San Jose-Sunnyvale-Santa Clara (CA) $381.30 San Jose-Sunnyvale-Santa Clara (CA) $380.18 San Francisco-Oakland-Berkeley (CA) $373.53 San Francisco-Oakland-Berkeley (CA) $373.26 Alaska (AK) $368.96 Napa (CA) $354.79 Vallejo (CA) $354.39 NYC Suburbs/Long Island (NY) $344.57 National average $298.60 … 97 more localities between … Rest Of Missouri (MO) $275.76 Alabama (AL) $274.63 Mississippi (MS) $273.72 Arkansas (AR) $271.59

Non-facility payment for 99496 in the 2026 fee schedule ($33.4009 conversion factor), before sequestration. Gray bar = national average.

Global period: XXX

No global period: the global surgery concept does not apply to this code.

Related codes - digital, remote monitoring & care management

99421 · online digital e/m, 5-10 minutes over 7 days
99422 · online digital e/m, 11-20 minutes over 7 days
99423 · online digital e/m, 21+ minutes over 7 days
98966 · telephone assessment by qualified nonphysician, 5-10 minutes
98967 · telephone assessment by qualified nonphysician, 11-20 minutes
98968 · telephone assessment by qualified nonphysician, 21-30 minutes
99453 · remote physiologic monitoring, setup and patient education
99454 · remote physiologic monitoring, device supply per 30 days
99457 · remote physiologic monitoring management, first 20 minutes/month
99458 · remote physiologic monitoring management, each additional 20 minutes
98975 · remote therapeutic monitoring, setup and patient education
98977 · remote therapeutic monitoring, device supply per 30 days (musculoskeletal)
98980 · remote therapeutic monitoring management, first 20 minutes/month
98981 · remote therapeutic monitoring management, each additional 20 minutes
99490 · chronic care management, clinical staff, first 20 minutes/month
99439 · chronic care management, clinical staff, each additional 20 minutes
99491 · chronic care management by physician/qhp, first 30 minutes/month
99495 · transitional care management, moderate complexity (14-day contact)
99484 · general behavioral health integration care management, per month

Frequently asked questions

How much does Medicare pay for 99496 in 2026?

The national non-facility payment is $298.60 and the facility payment is $166.34, using the standard $33.4009 conversion factor. Actual amounts vary by Medicare locality; use the RVU calculator for your area.

What is the work RVU for 99496?

The 2026 work RVU for 99496 is 3.79. Total RVUs are 8.94 in the non-facility setting and 4.98 in the facility setting.

Why are the facility and non-facility amounts different?

Only the practice expense component changes by setting. In an office (non-facility) the practice bears the overhead, so the PE RVU is higher; in a hospital or ASC the facility bills its own overhead separately.

Source: CMS Physician Fee Schedule relative value file (rvu26c.zip, retrieved 2026-07-11). Service description is an original plain-English summary, not CPT descriptor text. CPT® is a registered trademark of the American Medical Association. Amounts are estimates before sequestration and claim-level adjustments.