Home/res vst new sf mdm 15
CPT 99341 is billed when a doctor makes a home visit to see a new patient with straightforward medical problems that require about 15 minutes of care.
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
Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High
NCCI bundling edits
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Billing tips
Document total time spent on the date of encounter, including non-face-to-face activities like care coordination and medical record review
Impact: Time-based coding may allow upcoding to 99342 (30 min) at $87.69 if total time reaches 30 minutes, an $40.14 increase
Verify patient's new patient status (no professional services from same specialty within 3 years) before billing 99341
Impact: Incorrect new patient designation results in claim denial and rebilling at established rate of 99347 ($47.55), which may delay payment 30-60 days
Ensure straightforward MDM is clearly documented: minimal diagnoses/management options, minimal data review, minimal risk
Impact: Insufficient MDM documentation triggers downcoding to 99341 or denial; proper documentation supports the $47.55 reimbursement
Bill place of service code 12 (home) rather than 11 (office) to ensure proper reimbursement
Impact: Incorrect POS code results in automatic denial; correction and resubmission delays payment by 2-4 weeks
Link appropriate ICD-10 codes that support medical necessity for home visit rather than office visit
Impact: Lack of documented homebound status or medical necessity can trigger medical review and potential denial of full claim amount
Do not bill 99341 with prolonged service codes unless total time significantly exceeds typical time and payer allows
Impact: Most payers do not allow prolonged services with lowest-level codes; unbundling attempts result in denial and potential audit risk
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