# CPT 99495

> Medicare paid $165.42 for CPT 99495 in the office (non-facility) setting and $111.35 in a facility under the Q3 2016 Physician Fee Schedule, effective July 2016. These are the national allowed amounts before the ~2% sequestration cut and before locality (GPCI) adjustment. This price has been unchanged since Q1 2016, when it decreased 0.6%.

## What it is

A bundle of services that manages a patient’s move from a hospital, skilled-nursing facility, or similar setting back to the community over the 30 days after discharge, for a case of moderate complexity — for example, coordinating follow-up after a hip-fracture repair with a few manageable chronic conditions. It requires an interactive contact (phone, in-person, or telehealth) within 2 business days of discharge and a face-to-face office visit within 14 calendar days.

## Selected release

- Release: Q3 2016 (2016 C)
- Effective: July 1 – September 30, 2016
- Status indicator: A
- Office (non-facility) national allowed amount: $165.42
- Facility national allowed amount: $111.35
- Sequestration: not applied

## RVUs and formula

- Work RVU: 2.11
- Office (non-facility) practice expense RVU: 2.38
- Facility practice expense RVU: 0.87
- Malpractice RVU: 0.13
- Conversion factor: 35.8043
- Formula: `(work_rvu × work_gpci + pe_rvu × pe_gpci + mp_rvu × mp_gpci) × conversion_factor`

## Source and citation

- Source: Physician relative value file (Q3 2016)
- CMS file: https://www.cms.gov/medicare/medicare-fee-for-service-payment/physicianfeesched/downloads/rvu16c.zip
- Parsed file: PPRRVU16_V0517.csv, row 16,301
- Canonical page: https://localishealth.com/cpt/99495/2016/A
- Release-specific citation URL: https://localishealth.com/cpt/99495/2016/C
- Last significant update: 2026-08-04T03:06:56+00:00