CPT 99348E&M

Home/res vst est low mdm 30

CPT 99348 is used when a doctor visits an established patient at their home or residence for a medical problem that requires straightforward decision-making and typically takes about 30 minutes.

Showing rates for

National Average

Base Medicare rate

$74.07

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

1.5

PE RVU (NF)

0.71

MP RVU

0.08

Total RVU

2.29

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

NCCI bundling edits

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Billing tips

Document all three components of MDM (number/complexity of problems, data reviewed, and risk) to justify low complexity level and prevent downcoding to 99347
Impact: Prevents $21.91 loss per visit (difference between 99348 at $74.07 and 99347 at $52.16)
Record total face-to-face time when it exceeds typical time by at least 15 minutes, allowing you to upcode to 99349 using prolonged service rules
Impact: Can increase reimbursement to $109.69 (99349 rate), a gain of $35.62 per visit when time-based coding is appropriate
Bill travel time separately using G0181 (per mile) for home health agency services or include in practice overhead; Medicare does not separately reimburse physicians for home visit travel time
Impact: Avoid claim denials by not attempting to bill travel time codes that are not recognized for physician services
Verify assisted living facility classification before coding; some facilities are considered institutional settings requiring different E/M codes (99334-99337 for domiciliary care)
Impact: Using wrong code series results in 100% denial; proper code selection ensures timely payment of $74.07
Document the specific home or residence address in medical record to support place of service code 12 and defend against facility-based coding audits
Impact: Prevents audit recoupment and establishes medical necessity for home visit versus office visit
Batch home visits geographically and schedule multiple patients in same area on same day to maximize the 2.29 RVUs per visit efficiency
Improves practice productivity by reducing travel time overhead per visit, maximizing hourly RVU generation

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 99348 in 2025?

The 2025 Medicare national average payment rate for CPT 99348 is $74.07 for both facility and non-facility settings. This is based on 2.29 total RVUs multiplied by the 2025 conversion factor of 32.3465. Actual payment may vary by geographic locality based on GPCI adjustments.

How long should a 99348 home visit take?

CPT 99348 has a typical time of 30 minutes of face-to-face contact with the patient. However, time is not required for code selection unless using time-based coding rules. When total time reaches 45 minutes or more, you may qualify for 99349 instead.

What's the difference between 99348 and 99349?

99348 requires low level medical decision making with typical time of 30 minutes, while 99349 requires moderate level MDM with typical time of 40 minutes. The reimbursement difference is significant: 99348 pays $74.07 versus 99349 at $109.69, a difference of $35.62.

Can I bill 99348 for assisted living facility visits?

It depends on the facility type. Use 99348 for independent living or residential settings where the patient has a private residence. Use domiciliary care codes (99334-99337) for assisted living facilities that provide custodial care. Verify facility licensure and classification to select the correct code series.

How many times can I bill 99348 for the same patient?

Medicare doesn't have a specific frequency limit for 99348, but each visit must be medically necessary and documented. Payers may audit high-frequency patterns. Best practice is to space routine home visits appropriately based on clinical need and consider care coordination or chronic care management codes for frequent touchpoints.

What modifiers are commonly used with CPT 99348?

Modifier 25 is most common when a separately identifiable E/M service occurs on the same day as a procedure. Modifier 95 may be used for telemedicine visits if permitted. Modifier AI identifies physician assistant services. Modifiers 76/77 for repeat visits same day are rarely appropriate and often denied.

Do I need to document why the patient can't come to the office for 99348?

While not universally required by all payers, documenting homebound status or medical necessity for the home visit strengthens your claim and appeals. Some Medicare LCDs specifically require justification. At minimum, document patient's functional status and why home-based care is medically appropriate to defend against potential audits.