# CPT 99496

> Medicare paid $281.59 for CPT 99496 in the office (non-facility) setting and $197.49 in a facility under the Q2 2021 Physician Fee Schedule, effective April 2021. These are the national allowed amounts before the ~2% sequestration cut and before locality (GPCI) adjustment. This price has been unchanged since Q1 2021, when it increased 13.6%.

## 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 2021 (2021 B)
- Effective: April 1 – June 30, 2021
- Status indicator: A
- Office (non-facility) national allowed amount: $281.59
- Facility national allowed amount: $197.49
- Sequestration: not applied

## RVUs and formula

- Work RVU: 3.79
- Office (non-facility) practice expense RVU: 4.05
- Facility practice expense RVU: 1.64
- Malpractice RVU: 0.23
- Conversion factor: 34.8931
- Formula: `(work_rvu × work_gpci + pe_rvu × pe_gpci + mp_rvu × mp_gpci) × conversion_factor`

## Source and citation

- Source: Physician relative value file (Q2 2021)
- CMS file: https://www.cms.gov/files/zip/rvu21b-updated-03022021.zip
- Parsed file: PPRRVU21_APR.csv, row 17,327
- Canonical page: https://localishealth.com/cpt/99496/2021/A
- Release-specific citation URL: https://localishealth.com/cpt/99496/2021/B
- Last significant update: 2026-08-04T03:10:33+00:00