CPT 99495 · professional fee

Transj care mgmt mod f2f 14d (CPT 99495): negotiated rates by payer and state

What UnitedHealthcare, Aetna, Cigna and Blue Cross Blue Shield pay for CPT 99495, from their published in-network rate files.

Internal medicineSnapshot Aug 2026Professional fee only

National summary

Commercial in-network, four payers combined, professional fee

Median rate

$211

P10 to P90: $128 to $393

vs Medicare

96%

non-facility rate $220.11

Payer spread

1.88×

UHC $278 vs Aetna $148

State spread

2.9×

AK $384 to AL $131

5,456 sampled providers7,701 TINs51 statesSample-based · how this is calculated

What the data shows

Generated from this code's own numbers

UnitedHealthcare has the highest median for CPT 99495 in the files analyzed, at $278, 88% above Aetna ($148), the lowest of the 4 payers shown.

The state spread is 2.9×: Alaska has the highest median at $384 and Alabama the lowest at $131, a gap larger than the gap between the highest and lowest payer.

Commercial rates run 96% of the Medicare non-facility rate ($220.11), which ranks 202nd of 228 tracked codes by commercial-to-Medicare ratio.

Rates are tightest within Aetna (interquartile range $59) and widest within UnitedHealthcare ($171).

This is a top-23 code for internal medicine by Medicare allowed dollars, so it carries real revenue weight for that specialty.

Rates by payer

Median of per-provider median rates, with interquartile range

Payer	Median	P25	P75	vs national	Rank	Providers	Position
UnitedHealthcare	$278	$210	$381	+32%	1	4,250	126% of Medicare
Cigna	$211	$162	$261	-0%	2	4,157	96% of Medicare
Blue Cross Blue Shield	$207	$159	$277	-2%	3	4,168	94% of Medicare
Aetna	$148	$126	$185	-30%	4	2,991	67% of Medicare

Rate distribution

Box = P25 to P75, whiskers = P10 to P90, tick = median, dashed line = Medicare non-facility ($220.11)

Rates by state

Median across payers · 51 states with enough data

Rank	State	Median	vs national	Highest payer	Lowest payer	Providers
1	Alaska	$384	+82%	UHC	Cigna	97
2	Wisconsin	$365	+73%	UHC	Aetna	106
3	Minnesota	$351	+66%	UHC	Aetna	112
4	Oregon	$333	+58%	UHC	Aetna	98
5	North Dakota	$314	+49%	BCBS	Aetna	108
6	Washington	$303	+43%	UHC	Aetna	109
7	Nebraska	$302	+43%	UHC	BCBS	89
8	Massachusetts	$273	+29%	UHC	Aetna	121
9	Hawaii	$268	+27%	Cigna	BCBS	76
10	New Hampshire	$259	+23%	UHC	Aetna	110
11	Georgia	$257	+22%	UHC	Aetna	120
12	North Carolina	$254	+20%	UHC	Aetna	124
13	Wyoming	$249	+18%	UHC	Aetna	106
14	District of Columbia	$235	+11%	UHC	BCBS	83
15	Colorado	$233	+10%	UHC	Aetna	115
16	Vermont	$229	+8%	UHC	BCBS	107
17	Maine	$227	+8%	UHC	Aetna	120
18	Connecticut	$225	+7%	UHC	Aetna	118
19	New Jersey	$220	+4%	BCBS	Aetna	113
20	Montana	$219	+4%	UHC	BCBS	103
21	Pennsylvania	$217	+3%	UHC	Aetna	108
22	Idaho	$217	+3%	UHC	Aetna	107
23	Iowa	$211	+0%	UHC	Aetna	99
24	South Dakota	$211	-0%	UHC	Aetna	123
25	New Mexico	$211	-0%	UHC	Aetna	103
26	New York	$209	-1%	UHC	Aetna	114
27	Ohio	$207	-2%	UHC	Aetna	120
28	Utah	$204	-4%	UHC	Aetna	107
29	South Carolina	$203	-4%	UHC	Aetna	101
30	California	$202	-4%	UHC	Aetna	97
31	West Virginia	$200	-6%	UHC	Aetna	114
32	Illinois	$196	-7%	UHC	BCBS	87
33	Kansas	$196	-7%	UHC	Aetna	102
34	Oklahoma	$196	-7%	UHC	Aetna	109
35	Virginia	$193	-9%	UHC	Aetna	97
36	Delaware	$192	-9%	UHC	BCBS	107
37	Rhode Island	$192	-9%	UHC	Aetna	97
38	Missouri	$186	-12%	UHC	BCBS	113
39	Maryland	$185	-12%	UHC	BCBS	94
40	Tennessee	$185	-13%	UHC	Aetna	105
41	Indiana	$181	-14%	UHC	Aetna	123
42	Louisiana	$179	-15%	UHC	Aetna	110
43	Kentucky	$176	-17%	UHC	BCBS	127
44	Arkansas	$171	-19%	UHC	Aetna	121
45	Texas	$169	-20%	UHC	BCBS	121
46	Arizona	$169	-20%	UHC	BCBS	95
47	Mississippi	$167	-21%	BCBS	Aetna	101
48	Florida	$159	-25%	UHC	Aetna	102
49	Nevada	$158	-25%	UHC	Aetna	110
50	Michigan	$151	-29%	UHC	Aetna	104
51	Alabama	$131	-38%	UHC	Aetna	103

Frequently asked questions

Answers use this page's data

Which payer has the highest median rate for CPT 99495?

In the files we analyzed, UnitedHealthcare, at a median of $278 across 4,250 sampled providers. Aetna is lowest at $148, 88% lower than the highest.

How does the commercial rate compare with Medicare?

The national median is 96% of the 2026 Medicare non-facility rate of $220.11.

Which state has the highest median for CPT 99495?

Alaska has the highest median at $384; Alabama has the lowest at $131.

Is this a professional fee?

These are professional (physician) fees only. Facility, device and implant payments are priced separately and are not included.

How current is this data?

It is the August 2026 snapshot of each payer's in-network rate file. Sources and filters are listed in the methodology below.

Methodology

How these numbers are calculated

Source: in-network negotiated-rate files published under the federal Transparency in Coverage rule, August 2026 snapshot: UnitedHealthcare Choice plans (74 files); Aetna commercial plans (70 files); Cigna national PPO (1 files); BCBS licensees' own-network files (5,387 files). Payer comparisons describe these files, not each payer's entire book of business.
Sample: rates come from a random sample of up to 150 providers per state and specialty. Counts on this page are sampled providers and TINs, not totals.
Which providers count: only providers in a specialty relevant to the code, because a rate in a payer file attaches to a provider group and is listed under every provider in that group.
Filters: fee-for-service, professional billing class, no modifier, negotiated or fee-schedule dollar rates. Rates outside 1% to 1,000% of the Medicare rate are excluded.
Statistic: one median rate per provider, then percentiles across providers. A cell is shown only with at least 15 sampled providers and 4 TINs.
Medicare benchmark: CY2026 national physician fee schedule, non-QPP conversion factor, unadjusted for locality. Where the non-facility rate is more than twice the facility rate (office rates that include device or supply cost), the facility rate is used so comparisons are like for like.

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