CPT 99307E&M

Sbsq nf care sf mdm 10

CPT 99307 covers a follow-up visit by a physician or qualified healthcare professional to see a patient already established in a nursing facility or skilled nursing facility when the visit involves straightforward medical decision-making (about 10 minutes).

Showing rates for

National Average

Base Medicare rate

$38.49

This calculator gives a typical-case estimate using standard Medicare modifier rules. Actual payment depends on payer policies, documentation, code-specific CMS status indicators, and locality. Verify before billing.

RVU breakdown

Work RVU

0.7

PE RVU (NF)

0.45

MP RVU

0.04

Total RVU

1.19

Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High

NCCI bundling edits

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Billing tips

Bill only one subsequent nursing facility code (99307-99310) per patient per date of service, regardless of how many times you see the patient
Impact: Prevents automatic denial of duplicate claims; select the highest level supported by documentation for that day
Document medical decision-making elements clearly: number of diagnoses/problems addressed, data reviewed, and risk level
Impact: Under 2023+ E/M guidelines, MDM is the primary determinant; poor MDM documentation causes downcoding from 99308-99310 to 99307, losing $25-$75 per encounter
Use time-based coding only when counseling/coordination of care comprises more than 50% of the encounter; document total time and activities
Impact: Time can be used as alternative to MDM for code selection; for 99307, 10 minutes is typical, but must be clearly documented to support the code level
Do not bill 99307 within 30 days of discharging the patient from inpatient status if you were the admitting physician
Impact: Global period rules may apply; billing during post-discharge global period results in denial and potential recoupment
Verify that the facility type qualifies as a nursing facility; assisted living facilities typically require domiciliary codes (99334-99337) instead
Impact: Incorrect place of service coding leads to 100% denial; using 99307 for assisted living loses the entire $38.49 payment
For Medicare Advantage plans, verify whether the plan requires the AI modifier for principal physician identification
Impact: Missing required modifiers can delay payment by 30-60 days while payer requests corrected claims

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 99307 in 2025?

The 2025 Medicare national average reimbursement for CPT 99307 is $38.49 for both facility and non-facility settings. This is based on 1.19 total RVUs multiplied by the 2025 conversion factor of 32.3465. Actual payment may vary by geographic locality.

How often can I bill CPT 99307 for the same patient?

You can bill 99307 once per patient per date of service. There is no Medicare frequency limitation on how many days per month you can bill subsequent nursing facility visits, but only one subsequent NF code (99307-99310) can be billed per patient per day, regardless of how many times you see them.

What is the difference between CPT 99307 and 99308?

CPT 99307 requires straightforward medical decision-making with minimal complexity and typically 10 minutes of service time. CPT 99308 requires low complexity medical decision-making with increased problems, data review, or risk, and typically 20 minutes. The reimbursement difference is significant, with 99308 paying approximately $25 more than 99307.

Can I bill CPT 99307 for an assisted living facility visit?

No, CPT 99307 is only for patients residing in skilled nursing facilities or nursing facilities certified under Medicare/Medicaid. For assisted living facilities, use domiciliary care codes 99334-99337 instead. Using the wrong code family will result in claim denial.

What level of medical decision-making is required for CPT 99307?

CPT 99307 requires straightforward medical decision-making, which is the lowest MDM level. This means minimal number and complexity of problems addressed, minimal or no data reviewed/analyzed, and minimal risk of complications or morbidity. Examples include stable chronic conditions requiring routine follow-up.

Do I need to document time for CPT 99307?

Time documentation is optional unless you are using time as the basis for code selection instead of medical decision-making. For 99307, typical time is 10 minutes. If counseling/coordination dominates the visit (>50% of time), you may select the code level based on total time spent, but this must be clearly documented.

Can nurse practitioners and physician assistants bill CPT 99307?

Yes, qualified nonphysician practitioners (NPs and PAs) can bill CPT 99307 under their own NPI if they have appropriate state licensure and facility privileges. Medicare typically reimburses NPs and PAs at 85% of the physician fee schedule rate, which would be approximately $32.72 for 99307 in 2025.