Home/res vst est low mdm 30
CPT 99348 covers a follow-up visit to an established patient at their home or residence when the medical decision-making is straightforward and low complexity, typically lasting 30 minutes.
RVU breakdown
Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High
Billing tips
Document the specific location of service (private home, assisted living, etc.) in the medical record and ensure place of service code 12 (home) is used on the claim
Impact: Incorrect POS codes cause automatic denials; using POS 11 (office) instead of 12 reduces reimbursement and triggers audits
Clearly document the low complexity MDM elements: number and complexity of problems addressed, amount/complexity of data reviewed, and risk of complications
Impact: Insufficient MDM documentation is the #1 reason for downcoding from 99348 to 99347, resulting in a loss of approximately $25-30 per visit
Use time-based billing when total time on the date of encounter exceeds typical time and prolonged service codes apply (99417 for additional 15 minutes)
Impact: When visit extends beyond 40 minutes, adding 99417 can increase reimbursement by $37-45 per additional 15-minute increment
Bill separately for care plan oversight (99339-99340) and transitional care management (99495-99496) when applicable, as these are not bundled with 99348
Impact: Failing to capture these separately billable services leaves $80-200+ per month uncaptured for complex home-based patients
For Medicare patients, verify homebound status documentation is current if patient also receives home health services to avoid coordination of benefits issues
Impact: Coordination issues can delay payment 30-60 days and create reconciliation headaches even though services are separately payable
Ensure established patient criteria is met (professional encounter within past 3 years by same physician or same group/specialty); otherwise use new patient codes 99341-99345
Impact: Billing 99348 for a new patient results in denial and requires rebilling with correct code, delaying payment and potentially reducing reimbursement by $50-100
Common denials
Place of service code does not match the service location (e.g., POS 11 used instead of POS 12)
How to appeal: Submit corrected claim with POS 12 and include documentation showing service was rendered at patient's home/residence. Include address of service location in appeal letter.
Medical necessity not established or documentation does not support low complexity MDM level
How to appeal: Provide complete visit note highlighting the 2-3 elements of MDM (problem complexity, data reviewed, risk level). Reference CPT guidelines and 2021 E&M framework showing low complexity criteria was met. Include clinical rationale for home visit necessity.
Service billed as established patient but no prior encounter documented within 3-year window
How to appeal: If truly established, provide documentation of prior encounter with date of service. If new patient, submit corrected claim with appropriate 99341-99345 code and request reconsideration at new patient rate.
Frequency limitations or medical necessity questioned for multiple home visits in short timeframe
How to appeal: Provide detailed clinical explanation of why multiple home visits were necessary (acute exacerbation, medication adjustments requiring monitoring, post-hospital follow-up). Reference clinical guidelines supporting visit frequency for specific diagnosis. Include homebound justification if applicable.
Frequently asked questions
What is the Medicare reimbursement rate for CPT 99348 in 2025?
The 2025 Medicare national average reimbursement rate for CPT 99348 is $74.07 for both facility and non-facility settings. This is based on a total RVU of 2.29 and the 2025 conversion factor of 32.3465. Actual payment may vary by locality based on geographic practice cost indices (GPCIs).
Can I bill CPT 99348 for a telehealth visit to a patient's home?
Generally, 99348 requires an in-person home visit. However, during COVID-19 public health emergency waivers, some payers allowed home visit codes via telehealth with modifier 95. Check current payer policies as most telehealth flexibilities have expired. For standard telehealth, use office visit codes (99212-99215) with appropriate place of service and modifiers.
What is the difference between CPT 99348 and 99349 for home visits?
Both codes are for established patient home visits, but 99348 involves low complexity medical decision-making (typically 30 minutes), while 99349 involves moderate complexity MDM (typically 40 minutes). The primary distinction is the complexity of problems addressed, data reviewed, and risk level, not just time spent. CPT 99349 reimburses at a higher rate due to increased complexity.
What place of service code should I use when billing CPT 99348?
Use place of service code 12 (home) for services provided in a private residence. For assisted living facilities, use POS 13. For group homes, use POS 14. Using the incorrect POS code (such as POS 11 for office) will result in claim denial or incorrect payment.
How many RVUs is CPT 99348 worth in 2025?
CPT 99348 has a total of 2.29 RVUs in 2025, consisting of 1.5 work RVUs, 0.71 practice expense RVUs (both facility and non-facility), and 0.08 malpractice RVUs. These values are from the CMS Medicare Physician Fee Schedule RVU25A released December 23, 2024.
Can I bill CPT 99348 and a procedure code on the same day?
Yes, you can bill 99348 with a procedure code on the same day if the E&M service is separately identifiable and significant beyond the usual pre/post-procedure work. Append modifier 25 to the 99348 code and ensure documentation clearly shows the distinct E&M service with separate medical decision-making from the procedure.
What qualifies as an established patient for CPT 99348?
An established patient is one who has received professional face-to-face services from the physician or another physician of the same specialty in the same group practice within the previous three years. If this criterion is not met, you must use new patient home visit codes (99341-99345) instead of 99348.