# CPT 99496

> Medicare paid $233.57 for CPT 99496 in the office (non-facility) setting and $162.06 in a facility under the Q4 2015 Physician Fee Schedule, effective October 2015. These are the national allowed amounts before the ~2% sequestration cut and before locality (GPCI) adjustment. This is a 0.5% increase from the previous quarter.

## What it is

The month of care that follows a patient home from a hospital or skilled nursing facility, at the more demanding of the two available levels. It bundles a phone or electronic contact within about two business days of discharge, ongoing coordination through the following month, and an office visit - which for this level has to happen within roughly the first week home rather than the two weeks allowed for the lower-level service. The other thing that sets it apart is the difficulty of the medical decision-making involved, which must be high rather than moderate.

## Selected release

- Release: Q4 2015 (2015 D)
- Effective: October 1 – December 31, 2015
- Status indicator: A
- Office (non-facility) national allowed amount: $233.57
- Facility national allowed amount: $162.06
- Sequestration: not applied

## RVUs and formula

- Work RVU: 3.05
- Office (non-facility) practice expense RVU: 3.26
- Facility practice expense RVU: 1.27
- Malpractice RVU: 0.19
- Conversion factor: 35.9335
- Formula: `(work_rvu × work_gpci + pe_rvu × pe_gpci + mp_rvu × mp_gpci) × conversion_factor`

## Source and citation

- Source: Physician relative value file (Q4 2015)
- CMS file: https://www.cms.gov/medicare/medicare-fee-for-service-payment/physicianfeesched/downloads/rvu15d.zip
- Parsed file: PPRRVU15_OCT05_V1001.csv, row 16,084
- Canonical page: https://localishealth.com/cpt/99496/2015/D
- Release-specific citation URL: https://localishealth.com/cpt/99496/2015/D
- Last significant update: 2026-08-04T03:06:14+00:00