CPT 99347E&M

Home/res vst est sf mdm 20

CPT 99347 is billed when a physician visits an established patient at their home or residence for a problem requiring straightforward medical decision-making, typically a 20-minute visit.

Showing rates for

National Average

Base Medicare rate

$43.67

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

0.9

PE RVU (NF)

0.41

MP RVU

0.04

Total RVU

1.35

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

NCCI bundling edits

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Billing tips

Document total visit time and medical decision-making elements to support level selection; 99347 requires straightforward MDM or 20 minutes total time
Impact: Underdocumentation risks downcoding to 99345 (loss of $17.09 per visit); overdocumentation without clinical support may trigger upcoding audits
Verify patient's established status (prior face-to-face encounter with same physician/group within 3 years) before using 99347
Impact: Billing established patient codes for new patients results in denial and rebilling delays; new patient code 99344 pays $70.32, but requires new patient criteria
Code selection should be based on either medical decision-making OR total time, whichever is more advantageous and documented
Impact: 2021 E&M guidelines allow time-based coding; if visit reaches 30-39 minutes, upgrade to 99348 ($80.53), increasing revenue by $36.86
Document medical necessity for the home visit specifically, not just the clinical encounter; explain why office visit is inadequate
Impact: Medicare and commercial payers increasingly scrutinize home visit necessity; lack of homebound justification can result in full denial of $43.67
Bill mileage separately using codes 99374-99375 for care plan oversight if applicable, not as part of 99347
Impact: Travel time is not separately reimbursable for home visits, but care plan oversight (30+ minutes/month) can add $45-90 when documented properly
Use place of service code 12 (home) on claim form; incorrect POS codes trigger automatic denials
Impact: POS errors cause 100% claim rejection requiring resubmission; delays payment by 30-45 days and increases administrative burden

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 99347 in 2025?

Medicare pays $43.67 for CPT 99347 in 2025 based on the national average non-facility rate. This is calculated using 1.35 total RVUs multiplied by the 2025 conversion factor of 32.3465. Actual payment may vary by geographic locality.

How many RVUs is CPT code 99347 worth?

CPT 99347 is assigned 1.35 total RVUs for 2025, consisting of 0.9 work RVUs, 0.41 practice expense RVUs, and 0.04 malpractice RVUs. Both facility and non-facility RVU values are identical for this code.

What is the difference between 99347 and 99348?

99347 represents a home visit with straightforward medical decision-making or 20-29 minutes total time, while 99348 involves low complexity MDM or 30-39 minutes. The difference in 2025 Medicare payment is $36.86, with 99348 paying $80.53 compared to 99347's $43.67.

Can I bill 99347 for telehealth visits?

Generally no, CPT 99347 is specifically for in-person home visits. During the COVID-19 public health emergency, temporary waivers allowed some telehealth billing for home visit codes with modifier 95, but these flexibilities have largely expired. Check current CMS telehealth policies and use appropriate telehealth E&M codes (99441-99443 or 99421-99423) instead.

What documentation is required to bill CPT 99347?

Required documentation includes medical necessity for the home visit, chief complaint, relevant history and exam, straightforward medical decision-making elements (limited problems, minimal data, low risk), assessment and plan, total time if time-based coding, confirmation of established patient status, and physician signature. Must also document why home setting was necessary versus office visit.

How do I prove a patient is established for billing 99347?

A patient is established if they had a face-to-face encounter with the same physician or another physician of the same specialty in the same group practice within the previous 36 months. Documentation should reference prior visit dates. If no qualifying encounter exists, use new patient home visit codes 99341-99345 instead.

Can I bill 99347 and a procedure code on the same day?

Yes, you can bill 99347 with a procedure on the same day if the E&M service is separately identifiable and significant beyond the usual pre- and post-procedure work. Attach modifier 25 to the 99347 code and ensure documentation clearly shows the distinct E&M service with separate history, exam, and medical decision-making elements.