Home/res vst est mod mdm 40
CPT 99349 is used when a doctor visits an established patient at their home or residence for a problem requiring moderate complexity medical decision-making and typically 40 minutes of total visit time.
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 date of encounter, not just face-to-face time; include pre- and post-visit activities like reviewing records, care coordination, and documentation
Impact: Proper time documentation supports the 40-minute typical time and prevents downcoding to 99348, which would reduce payment by approximately $41
Clearly document moderate complexity MDM by addressing at least 2 of 3 elements: moderate number/complexity of problems, moderate data review, or moderate risk of complications
Impact: MDM documentation prevents downcoding and supports the $122.59 payment level versus $81.59 for 99348
Use place of service code 12 (home) for private residences or appropriate facility codes for assisted living; incorrect POS codes trigger denials
Impact: Correct POS coding ensures clean claims and avoids automatic denials requiring resubmission delays
Bill mileage separately using code 99490 or per-mile charges where allowed; many commercial payers reimburse travel time/distance in addition to visit code
Impact: Travel reimbursement can add $20-$50 per visit depending on distance and payer policy
Consider Chronic Care Management (99490) or Principal Care Management (99424-99427) for qualifying patients seen at home to capture additional monthly revenue
Impact: CCM adds approximately $42-$110 per patient per month for non-face-to-face care coordination
Verify patient is documented as established (seen within past 3 years by same specialty/group); if not established, must use new patient codes 99341-99345
Using established patient code for new patient results in denial and rebilling with new patient code 99344 would increase payment to $168.82
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