Home/res vst new mod mdm 60
CPT 99344 is used when a doctor visits a new patient at home or in a residential facility for a problem of moderate complexity that requires about 60 minutes of care. This includes comprehensive evaluation and medical decision-making for patients who cannot easily travel to a medical office.
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 pre- and post-visit work, to support the 60-minute typical time
Impact: Time-based coding can be used as alternative to MDM; inadequate time documentation may result in downcoding to 99343 (loss of $42-50)
Verify new patient status before billing - patient must not have received professional services from same provider or group in same specialty within past 36 months
Impact: Billing as new patient when established can result in denial and required refund; 99344 pays approximately $30-40 more than established equivalent (99349)
Document at least two of three MDM elements at moderate level: number/complexity of problems, data reviewed/analyzed, or risk of complications
Impact: Failure to meet moderate MDM criteria forces downcoding to 99343, reducing reimbursement by approximately $42 per visit
Code separately for prolonged services (99417) if total time exceeds 89 minutes on date of encounter
Impact: Additional 15-minute increments reimburse at approximately $46 each; not capturing prolonged time leaves $46+ on the table per qualifying visit
Ensure medical necessity justifies home visit versus office visit - document why patient cannot reasonably be seen in office
Impact: Medicare may deny without documented homebound status or medical necessity; home visits reimburse similarly to office but face higher scrutiny
Bill same day as care coordination services (99490, 99491) only if time periods do not overlap and both are separately documented
CCM services add $43-$94/month when properly separated from E&M time; overlapping time results in denial of CCM charges
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