CPT 99308E&M

Sbsq nf care low mdm 20

CPT 99308 is used when a doctor visits a nursing facility patient for a follow-up visit involving straightforward medical decision-making and at least 20 minutes of total time on the visit date.

Showing rates for

National Average

Base Medicare rate

$71.81

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

1.3

PE RVU (NF)

0.84

MP RVU

0.08

Total RVU

2.22

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

NCCI bundling edits

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Billing tips

Document total time on date of encounter (minimum 20 minutes) including chart review, exam, orders, and care coordination even when not face-to-face
Impact: Ensures proper code selection and prevents $15-25 downcoding to 99307; time-based documentation supports medical necessity in audits
Bill only once per day per physician/group even if multiple visits occur; use highest appropriate level code for combined service
Impact: Prevents automatic denial of duplicate claims; combining documentation to support 99309 or 99310 can increase reimbursement by $35-140
Verify Medicare Part A SNF consolidated billing rules; 99308 may be included in facility per diem during Part A stay
Impact: Billing during Part A SNF stay results in 100% denial; verify patient is in Part B status to ensure $71.81 payment
Document two of three MDM elements (problems addressed, data reviewed, or risk) to meet low complexity threshold
Impact: Missing MDM documentation triggers downcoding to 99307 ($56.36), resulting in $15.45 loss per visit
Use place of service code 31 (SNF) or 32 (nursing facility) consistently with facility type
Impact: Incorrect POS code causes claim rejection or audit flags; both POS codes reimburse identically at $71.81 but must match actual location
Review Medicare's 30-day rule for new vs. subsequent visits when patient transfers between facilities or returns from hospital
Impact: Using 99308 instead of initial visit code 99304-99306 during required initial period results in denial and requires claim resubmission

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Frequently asked questions

What is the Medicare reimbursement rate for CPT code 99308 in 2025?

The 2025 Medicare national average reimbursement for CPT 99308 is $71.81 for both facility and non-facility settings. This rate is based on 2.22 total RVUs multiplied by the conversion factor of 32.3465. Actual reimbursement may vary by geographic locality based on GPCI adjustments.

How much time is required to bill CPT code 99308?

CPT 99308 requires a minimum of 20 minutes of total time on the date of encounter. This includes face-to-face time with the patient and additional time spent on the unit/floor for activities such as chart review, writing orders, and coordinating care. Time does not need to be continuous.

Can CPT 99308 be billed during a Medicare Part A SNF stay?

No, CPT 99308 typically cannot be billed separately during a Medicare Part A SNF stay as these services are included in the facility's consolidated billing and SNF Prospective Payment System (PPS) rate. The code can only be billed when the patient is in Part B status or the service is specifically excluded from consolidated billing.

What is the difference between CPT 99308 and 99309?

CPT 99308 requires low complexity medical decision-making and typically 20 minutes of total time, while 99309 requires moderate complexity MDM and typically 30 minutes. The reimbursement difference is approximately $35, with 99309 paying around $107 compared to 99308's $71.81.

How often can CPT 99308 be billed for the same patient?

CPT 99308 can be billed once per day per physician or same-specialty group. Frequency of billing (daily, weekly, monthly) must be medically necessary and documented. Medicare does not have a specific limit on frequency, but excessive patterns may trigger audits requiring justification of medical necessity.

What level of medical decision-making is required for 99308?

CPT 99308 requires low complexity medical decision-making, which means at least two of the following: limited number and complexity of problems addressed, limited amount and complexity of data to be reviewed and analyzed, or low risk of complications or morbidity from treatment. This is the second-lowest MDM level for subsequent nursing facility visits.

Can nurse practitioners bill CPT 99308 independently?

Yes, nurse practitioners and physician assistants can bill CPT 99308 independently in nursing facilities where state scope of practice laws permit. Medicare reimburses NPPs at 85% of the physician fee schedule rate ($61.04 for 99308 in 2025) when billing under their own NPI, or at 100% when using incident-to billing rules with proper physician supervision.