Sbsq nf care low mdm 20
CPT code 99308 is used when a doctor visits a patient already in a nursing facility for a follow-up visit involving straightforward medical decision-making and typically 20 minutes of care.
RVU breakdown
Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High
Billing tips
Document total time on date of encounter when time is used as the basis for code selection
Impact: Time-based coding can support 99308 when MDM is borderline; failure to document time risks downcoding to 99307 ($52.84), resulting in $18.97 loss per visit
Verify frequency limitations with Medicare and secondary payers before billing multiple visits in a month
Impact: Medicare typically allows one SNF visit per discipline per day; violating frequency limits results in 100% denial ($71.81 loss)
Ensure the medical necessity of the subsequent visit is clearly documented, not just routine facility rounds
Impact: Lack of medical necessity is a top denial reason; proper documentation prevents denials and potential recoupment of $71.81 per visit during audits
Bill 99308 only when patient is not in a Medicare Part A covered SNF stay; use 99318 for required SNF assessments
Impact: Incorrect code selection when Part A SNF consolidated billing applies results in denial; proper code selection ensures payment
Distinguish between 99308 (subsequent) and 99304-99306 (initial) based on whether this is the first visit after admission
Impact: Initial visits reimburse higher (99304 = $94.83); using 99308 for initial visits loses $23.02, while using initial codes for subsequent visits risks audit findings
Document two of three key components (history, exam, MDM) for subsequent visits, with MDM being the primary driver
Impact: Insufficient documentation of MDM elements (problems addressed, data reviewed, risk) can trigger downcoding to 99307, losing $18.97 per encounter
Common denials
Service not medically necessary or appears to be routine facility rounds without specific medical indication
How to appeal: Submit appeal with documentation showing specific change in condition, new symptom, or specific treatment requiring physician evaluation beyond routine care; include nursing notes or facility records showing the medical need for physician intervention
Frequency exceeded - multiple visits same day or excessive visits in benefit period without justification
How to appeal: Provide documentation of distinct medical problems requiring separate evaluation; include time stamps and distinct chief complaints; cite LCD guidelines allowing multiple visits when medically necessary and separately documented
Service included in SNF Part A consolidated billing or bundled with SNF assessment codes
How to appeal: Verify patient's Medicare Part A status; if patient is not in covered Part A stay, submit appeal with proof of Part B eligibility and SNF certification dates; if truly Part A, withdraw claim and bill appropriate SNF assessment code instead
Insufficient documentation to support level of service - MDM appears straightforward rather than low complexity
How to appeal: Submit complete medical record showing complexity elements: number and complexity of problems addressed, amount/complexity of data reviewed, and risk of complications; if documentation truly insufficient, accept downcoding to 99307 and improve future documentation
Frequently asked questions
What is the Medicare reimbursement rate for CPT 99308 in 2025?
The 2025 Medicare national average payment for CPT 99308 is $71.81 for both facility and non-facility settings. This is based on a total of 2.22 RVUs multiplied by the 2025 conversion factor of 32.3465. Local rates may vary by MAC jurisdiction.
How many RVUs is CPT code 99308 worth?
CPT 99308 has a total of 2.22 RVUs in 2025, consisting of 1.3 work RVUs, 0.84 practice expense RVUs, and 0.08 malpractice RVUs. Both facility and non-facility PE RVUs are identical at 0.84 for this code.
What is the difference between CPT 99308 and 99309?
CPT 99308 represents subsequent nursing facility care with low complexity medical decision-making and typically 20 minutes of time, while 99309 involves moderate complexity MDM with typically 30 minutes. The higher complexity and time of 99309 results in higher reimbursement and requires more extensive documentation of medical decision-making elements.
Can CPT 99308 be billed for telemedicine visits in nursing facilities?
Telemedicine billing for 99308 depends on current CMS regulations and state/payer policies. During the COVID-19 PHE, SNF telemedicine was expanded, but post-PHE rules have become more restrictive. When permitted, use modifier 95 or GT and verify the patient is not in a Part A SNF stay where telemedicine rules may differ.
How often can you bill CPT 99308 for the same patient?
Medicare generally allows one E/M visit per discipline per day unless medically necessary and separately documented. There is no specific monthly limit on 99308, but frequency must be medically justified. Payers may review patterns showing daily or excessive visits without clear medical necessity, so documentation should support each visit's need.
What documentation is required to bill CPT 99308?
Documentation must include an interval history, focused examination, and medical decision-making showing low complexity (typically 2+ self-limited problems or 1 stable chronic condition). Include assessment/plan for each problem, any data reviewed, total time if using time-based coding (20 minutes), and provider signature with credentials. The note must demonstrate medical necessity beyond routine rounds.
Can nurse practitioners and physician assistants bill CPT 99308?
Yes, NPs and PAs can bill 99308 under their own NPI at 85% of the physician fee schedule rate (approximately $61.04 in 2025) when state scope of practice and facility policies allow. They may also bill incident-to at 100% ($71.81) when working under direct physician supervision and meeting all incident-to requirements, though this is less common in SNF settings.