CPT 99350E&M

Home/res vst est high mdm 60

CPT 99350 is used when a physician visits an established patient at their home or residence for a complex medical problem that requires approximately 60 minutes of face-to-face time and high-level medical decision making.

Showing rates for

National Average

Base Medicare rate

$177.91

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

3.6

PE RVU (NF)

1.67

MP RVU

0.23

Total RVU

5.5

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

NCCI bundling edits

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Billing tips

Document high MDM criteria explicitly: either 2 of 3 elements (extensive problem complexity, extensive data review, high risk management) per 2021 E&M guidelines rather than relying on time alone
Impact: Prevents downcoding to 99349 ($139.71) saving $38.20 per visit; proper MDM documentation is the most common reason for level selection
For time-based billing when counseling/coordination exceeds 50% of visit time, document total face-to-face time and activities in detail; 60+ minutes supports 99350
Impact: Alternative pathway to justify high-level code when MDM documentation is borderline; ensures $177.91 vs $139.71 for 99349
Bill place of service code 12 (home) not 11 (office); both have same reimbursement ($177.91) but incorrect POS triggers denials
Impact: Avoids automatic denials requiring resubmission; POS 12 is required for home visit codes per Medicare guidelines
Do not bill same-day office visit and home visit for same patient; if patient comes to office, home visit cannot be billed that day
Impact: Prevents fraud flags and automatic denials; only one E&M per day unless modifier 25 used with procedure or separate diagnosis
Verify patient homebound status documentation in medical record; while not required for 99350 billing, supports medical necessity for home visit vs office
Impact: Reduces audit risk and supports medical necessity on review; explains why higher-cost home visit was warranted instead of $128-166 office visit
For NPPs billing incident-to physician, ensure physician is on-site at the residence (not applicable for home visits); NPPs should bill under own NPI at 85% rate ($151.22)

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 99350 in 2025?

Medicare pays $177.91 for CPT 99350 in 2025 based on the national average non-facility rate. Both facility and non-facility rates are identical at $177.91 for this code. The total RVU is 5.5 (3.6 work RVU + 1.67 practice expense + 0.23 malpractice) multiplied by the 2025 conversion factor of 32.3465.

How many minutes are required for billing CPT 99350?

While 60 minutes is the typical time associated with 99350, time is not required for code selection. Under 2021 E&M guidelines, you can bill 99350 based on high complexity medical decision making alone. If using time for code selection, document 60+ minutes of total face-to-face time on the date of encounter when counseling and coordination dominate the visit.

What is the difference between CPT 99350 and 99349?

CPT 99350 requires high complexity medical decision making while 99349 requires moderate complexity MDM. Medicare pays $177.91 for 99350 versus $139.71 for 99349, a difference of $38.20. The time typically associated is 60 minutes for 99350 and 40 minutes for 99349, but MDM level is the primary differentiator under current guidelines.

Can nurse practitioners bill CPT 99350 for home visits?

Yes, nurse practitioners and physician assistants can bill 99350 under their own NPI. Medicare reimburses NPPs at 85% of the physician rate, which equals $151.22 for 99350 in 2025. Incident-to billing rules do not apply to home visits, so NPPs must bill under their own credentials even if a physician is involved in the practice.

What place of service code should be used with 99350?

Use place of service code 12 (home) for CPT 99350. This applies whether the patient lives in a private home, apartment, or non-institutional residence. Do not use POS 11 (office) as this will result in claim denial. Assisted living facilities typically use POS 13, while skilled nursing facilities use different E&M codes (99307-99310), not 99350.

How often can you bill CPT 99350 for the same patient?

There is no specific Medicare frequency limit for 99350, but each visit must be medically necessary and documented accordingly. Frequent home visits (multiple per week) will trigger utilization review and require strong clinical justification showing acute changes, new problems, or complex management needs. Establish clear documentation of distinct clinical purposes for each visit.

What documentation is needed to support high complexity MDM for 99350?

Document at least 2 of 3 MDM elements: (1) extensive number/complexity of problems (multiple chronic conditions with exacerbation, or one acute severe illness), (2) extensive amount/complexity of data (review and independent interpretation of tests, discussion with external providers, review of external records), or (3) high risk of complications or morbidity (prescription drug management requiring intensive monitoring, decision regarding hospitalization or escalation of care).