Home/res vst new mod mdm 60
CPT 99344 is used when a physician visits a new patient at their home or residence for a moderate-complexity medical evaluation lasting about 60 minutes. This code covers comprehensive assessments for patients who cannot easily travel to a medical office.
RVU breakdown
Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High
Billing tips
Document total time spent on the date of encounter including face-to-face and non-face-to-face time on the same day, as 2023+ E&M guidelines allow time-based code selection
Impact: Proper time documentation can support level selection and prevent downcoding; 60-74 minutes supports 99344, while 75+ minutes supports 99345 at $185.86
Clearly document medical necessity for home visit rather than office visit, including homebound status, mobility limitations, or safety concerns
Impact: Prevents denials for lack of medical necessity; home visit codes are scrutinized more heavily and may be denied if patient could reasonably visit office
Verify patient is truly 'new' (no services from same specialty within past 3 years); established patient home visits use 99347-99350 codes
Impact: Billing new patient code (99344) instead of established (99348) can result in $36-50 overpayment and potential fraud allegations
Ensure moderate MDM elements are documented: 3-4 self-limited/minor problems OR 2+ stable chronic conditions OR 1+ chronic condition with exacerbation; category 2 data review; moderate risk
Impact: Underdocumented MDM can result in downcoding to 99343 (low MDM, $104.56), losing $32.27 per visit
Submit claims with appropriate place of service code (12 for home, 13 for assisted living, 14 for group home) to match visit location
Impact: Incorrect POS codes trigger audits and potential denials; correct coding ensures proper payment and reduces audit risk
Do not bill same-day facility services (nursing facility, hospital) with home visit codes; these are mutually exclusive services
Impact: Prevents denials for impossibility/conflicting service location; billing both can trigger recoupment of full $136.83
Common denials
Patient classified as established rather than new (services within past 3 years by same specialty)
How to appeal: Submit appeal with documentation proving no prior services within 36 months, or if error, submit corrected claim with appropriate established patient code (99347-99350) and request voluntary refund if overpaid
Medical necessity for home visit not established (payer determines office visit was appropriate)
How to appeal: Provide detailed documentation of homebound status, mobility limitations, oxygen dependence, fall risk, or other barriers to office visit; include physician statement explaining why home setting was medically necessary
Insufficient documentation of moderate MDM or 60-minute time threshold
How to appeal: Submit complete visit note highlighting MDM elements (problems addressed, data reviewed, risk level) or contemporaneous time documentation; if note lacks detail, submit attestation if within correction timeframe
Place of service code mismatch with service location or patient residence type
How to appeal: Verify correct POS code and resubmit corrected claim; provide documentation of actual service location (private home vs. assisted living vs. group home) if disputed
Frequently asked questions
What is the Medicare reimbursement rate for CPT 99344 in 2025?
Medicare pays $136.83 for CPT 99344 in 2025 based on the national average non-facility rate. This rate is the same for both facility and non-facility settings ($136.83) with a total RVU of 4.23.
How long does a home visit need to be to bill CPT 99344?
CPT 99344 requires a typical time of 60-74 minutes of total time spent on the date of the encounter. This includes face-to-face time and non-face-to-face time on the same day related to the visit. If total time reaches 75 minutes, code 99345 should be used instead.
What is the difference between 99344 and 99348?
CPT 99344 is for new patients requiring 60 minutes and moderate MDM, while 99348 is for established patients requiring 40 minutes and moderate MDM. New patients have not received services from the same specialty within the past 3 years. Using the wrong code can result in significant payment differences and audit issues.
Can nurse practitioners bill CPT 99344 for home visits?
Yes, nurse practitioners can bill CPT 99344 under their own NPI according to their state scope of practice and Medicare non-physician practitioner rules, typically at 85% of the physician fee schedule ($116.31 in 2025). They may also bill incident-to a physician at 100% if all incident-to requirements are met, though this is challenging in home settings.
What qualifies as moderate medical decision making for 99344?
Moderate MDM requires meeting 2 of 3 elements: (1) moderate number/complexity of problems (3-4 self-limited problems, 2+ stable chronic conditions, or 1+ chronic condition with exacerbation), (2) moderate data review (category 2 data), and (3) moderate risk of complications. All elements must be documented in the visit note.
Does CPT 99344 require the patient to be homebound?
While CPT 99344 does not technically require homebound status like home health services, medical necessity for conducting the visit at home rather than in the office must be documented. This typically includes mobility limitations, safety concerns, oxygen dependence, or conditions making office visits unreasonably difficult. Payers scrutinize home visits for appropriate setting.
Can I bill CPT 99344 for assisted living facility visits?
Yes, CPT 99344 can be used for visits to assisted living facilities using place of service code 13. However, if the patient resides in a skilled nursing facility or nursing home, you must use nursing facility visit codes (99304-99310) instead. The patient's residential status, not temporary location, determines the appropriate code set.