# CPT 99496

> Medicare paid $233.99 for CPT 99496 in the office (non-facility) setting and $162.22 in a facility under the Q2 2017 Physician Fee Schedule, effective April 2017. These are the national allowed amounts before the ~2% sequestration cut and before locality (GPCI) adjustment. This price has been unchanged since Q1 2017, when it increased 0.4%.

## 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: Q2 2017 (2017 B)
- Effective: April 1 – June 30, 2017
- Status indicator: A
- Office (non-facility) national allowed amount: $233.99
- Facility national allowed amount: $162.22
- Sequestration: not applied

## RVUs and formula

- Work RVU: 3.05
- Office (non-facility) practice expense RVU: 3.28
- Facility practice expense RVU: 1.28
- Malpractice RVU: 0.19
- Conversion factor: 35.8887
- Formula: `(work_rvu × work_gpci + pe_rvu × pe_gpci + mp_rvu × mp_gpci) × conversion_factor`

## Source and citation

- Source: Physician relative value file (Q2 2017)
- CMS file: https://www.cms.gov/medicare/medicare-fee-for-service-payment/physicianfeesched/downloads/rvu17b.zip
- Parsed file: PPRRVU17_V0209.csv, row 16,467
- Canonical page: https://localishealth.com/cpt/99496/2017/A
- Release-specific citation URL: https://localishealth.com/cpt/99496/2017/B
- Last significant update: 2026-08-04T03:07:42+00:00