cpt home visit codes

Coding for E/M home visits changed this year. Here’s what you need to know

CPT has revised codes for at-home evaluation and management (E/M) services as of Jan. 1, 2023. Services to patients in a private residence (e.g., house or apartment) or temporary lodgings (e.g., hotel or shelter) are now combined with services in facilities where only minimal health care is provided (e.g., independent or assisted living) in these code families:

Home or residence E/M services, new patient

• 99341, straightforward medical decision making (MDM) or at least 15 minutes total time,

• 99342, low level MDM or at least 30 minutes total time,

• 99344 (code 99343 has been deleted), moderate level MDM or at least 60 minutes total time, 

• 99345, high level MDM or at least 75 minutes total time.

Home or residence services, established patient   

• 99347, straightforward MDM or at least 20 minutes total time,

• 99348, low level MDM or at least 30 minutes total time,

• 99349, moderate level MDM or at least 40 minutes total time,

• 99350, high level MDM or at least 60 minutes total time. 

Select these codes based on either your level of medical decision making or total time on the date of the encounter , similar to selecting codes for office visits . The E/M codes specific to domiciliary, rest home (e.g., boarding home), or custodial care (99324-99238, 99334-99337, 99339, and 99340) have been deleted, and the above codes should also be used in those settings.

When total time on the date of the encounter exceeds the threshold for code 99345 or 99350 by at least 15 minutes, you can add code 99417 to report prolonged services. The exception to this is for patients with Medicare. For those patients, report prolonged home or residence services to Medicare with code G0318 in addition to 99345 (requires total time ≥140 minutes) or 99350 (requires total time ≥110 minutes). Code G0318 is not limited to time on the date of the encounter, but includes any work within three days prior to the service or within seven days after.

Services provided in facilities where significant medical or psychiatric care is available (e.g., nursing facility, intermediate care facility for persons with intellectual disabilities, or psychiatric residential treatment facility) are reported with codes 99304-99310 .

— Cindy Hughes, CPC, CFPC

Posted on Jan. 19, 2023

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Disclaimer: The opinions and views expressed here are those of the authors and do not necessarily represent or reflect the opinions and views of the American Academy of Family Physicians. This blog is not intended to provide medical, financial, or legal advice. Some payers may not agree with the advice given. This is not a substitute for current CPT and ICD-9 manuals and payer policies. All comments are moderated and will be removed if they violate our Terms of Use .

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How to bill for a house call visit

More physicians are seeing the benefits of house calls , but at-home visits come with specific reimbursement and practical considerations. Here’s a quick overview of tips and CPT codes for the next time you bill for a house call visit.

Consider this when you bill for a house call

Medicare reimburses providers for home visits only if they are medically necessary. Healthcare.gov defines medically necessary services as “services or supplies that are needed to diagnose or treat a medical condition and that meet accepted standards of medical practice.”

In the case of house calls , physicians need to document that the home visit was medically necessary. In other words, you must present a medical rather than practical reason for visiting a patient outside the office. 

Here are a few reminders to consider before you bill for a house call:

• Providers need to document if the home visit is based upon a one-time, ongoing, or permanent need.
• Your documentation should prove that the patient is not physically capable of traveling to the office. You may base this assessment on physical or mental issues, not financial or personal matters.
• You can’t provide home services for your convenience as the physician.
• Patients receiving care under Medicare’s home health benefit must be confined to the home. However, patients don’t need to be home-bound for physicians to provide services billed under CPT codes 99341 through 99350.

The Office of Inspector General (OIG) and many CMS contractors regularly audit home services billed to Medicare. Always provide appropriate documentation showing that the house call was medically necessary.

“In other words, you must present a medical rather than practical reason for visiting a patient outside the office.” 

CPT Home Services Codes

Physicians use a limited set of CPT codes to bill for house calls. These codes apply to evaluation and management (E/M) services provided in a patient’s home. “Home” can include a private residence, temporary lodging, or short-term accommodation. 

As of January 2023, providers should also use these codes to bill for medical services delivered in assisted living facilities and other places where only minimal health care is provided. 

New patient CPT codes

99341 – Home visit for the evaluation and management of a new patient. This visit requires the following three components:

• A problem-focused history
• A problem-focused exam
• Straightforward medical decision making

Here’s a typical description for this code:

Counseling and/or coordination of care with other physicians, other qualified health care professionals, or other agencies are provided consistent with the nature of the problem(s) and the patients’ and/or family’s needs.

Usually, the presenting problem(s) are of low severity. Typically, the physician spends 20 minutes face-to-face with the patient and/or family.

99342 – Same as above, but this is a moderate severity problem requiring 30 minutes.

(CPT deleted code 99343 as of January 2023.)

99344 – Moderate to high severity problem, or at least 60 minutes total time.

99345 – Patient unstable or has a significant new problem requiring immediate attention (75 minutes).

Established patient CPT codes

99347 – Home visit for evaluating and managing an established patient. The visit requires at least two of these three key components.

• A problem-focused interval history
• A problem-focused examination

Here’s the typical description for this code:

Usually, the presenting problem(s) are self-limited or minor. Typically, you spend 15 minutes face-to-face with the patient and/or family.

99348 – Same as above, but this problem is low to moderate severity, requiring at least 30 minutes face-to-face.

99349 – Moderate to high problem requiring 40 minutes.

99350 – Patient unstable or has a significant new problem requiring immediate physician attention (60 minutes).

When making a house call, you may offer additional services such as advanced care planning, diagnosis services, or other minor procedures. These can be documented and billed in addition to the visit code.

How to select house call CPT codes

These tips from the AAFP will help you choose the correct codes:

• Select codes based on either your level of medical decision making (straightforward to complex) or the total time of the encounter. This is similar to selecting codes for office visits.
• When the total encounter time exceeds the threshold for code 99345 or 99350 by at least 15 minutes, you can add code 99417 to report prolonged services. However, if you saw a Medicare patient, report prolonged services with code G0318 in addition to 99345 (more details here ). 
• CPT deleted E/M codes specific to domiciliary, rest home, or custodial care (99324-99238, 99334-99337, 99339, and 99340). For those types of visits, use the codes above instead. 
• For services in facilities where significant medical or psychiatric care is available, use codes 99304-99310 .

2023 Updates to CPT Codes for House Call Visits

The CPT codes above reflect 2023 updates that combined two previously distinct E/M visit families: “Domiciliary, Rest Home (Boarding Home), or Custodial Care services” and “Home services.” These visit types are now collectively called “Home or Residence services” and are used to report E/M services provided to patients in their home/residence, assisted living facilities, group homes, custodial care facilities, and residential substance abuse treatment facilities. 

There are no changes to the care settings for the current code families. You can learn more about the recent updates in CMS’ Evaluation and Management Services Guide .

House calls: further reading

Here are some recommended articles for those interested in learning more about house calls:

• House calls are making a comeback
• The benefits of house calls for patients and providers
• 7 ways to easily document house calls on the go
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Billing and Coding for Physician Home Visits

by Rajeev Rajagopal | Published on May 23, 2018 | Medical Coding

Physician home visits have begun making a comeback, according to a recent report from the Association of American Medical Colleges (AAMC). With 80% of U.S. adults age 65+ having one or more chronic diseases, this is a welcome development. Point of care testing along with advancements in home health technology and support have improved the physician’s ability to cater to the needs of older weak patients with multiple comorbidities outside the office setting. Outsourcing medical coding can ensure accurate claim submission for optimal reimbursement for services provided. However, to qualify for coverage, the medical record must document the medical necessity of the home visit made in lieu of an office or outpatient visit. The Office of Inspector General (OIG) and several contractors of the Centers for Medicare & Medicaid Services (CMS) scrutinize physician home services billed to the Medicare program to ensure that house calls are medically necessary and not for the convenience of the patient, the patient’s family, or the physician (or provider).

Don’t let complex billing and coding processes hold you back from providing quality patient care.

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Physician Home Visits must be “Medically Necessary”

Medicare.gov defines “medically necessary” as “health-care services or supplies needed to prevent, diagnose, or treat an illness, injury, condition, disease, or it’s symptoms and that meet accepted standards of medicine”.

CPT codes 99341 through 99350, Home Services codes, are used to report E/M services provided to a patient residing in his or her own private residence and not any type of facility. According to a 2017 AAPC report:

• For home visits to qualify as medically necessary, providers need to document if the home visit is based upon a one-time need, or if the visit is provided to meet an ongoing or permanent need because of the patient’s physical, medical, mental, or psychological issues.
• The physician should provide proof that the patient is not physically capable of traveling to the office either this one time, or on an ongoing basis, due to physical or mental issues and not due to financial or other personal reasons.
• Home services cannot be provided at the physician’s convenience (for e.g., visiting senior independent living facilities on a routine basis, without requests for or by patients).
• Under Medicare’s home health benefit, the beneficiary must be confined to the home for services to be covered.
• For home services provided by a physician billed under CPT codes 99341 through 99350, the beneficiary does not need to be confined to the home.

CGS Adminstrators, LCC points out that if the physician visits the patient in his/her home on a regular basis, each note should show how the patient’s condition has changed. Providers should take care to avoid cloned or copied documentation that does not explain how the patient’s condition has improved or deteriorated.

Home Services CPT Code Range 99341- 99350

Codes 99341-99350 report evaluation and management (E/M) services provided in a private residence (place of service 12) and cannot be used if the patient resides in a shared living facility or group home. The description of home visits includes the average time to be used when counseling/coordination of care dominate the visit (for e.g., comprises over 50 percent of total face-to-face time between the provider and patient).

Codes for New Patients

99341 Home visit; low severity problem, 20 min. 99342 moderate severity problem, 30 min. 99343 moderate to high severity problem, 45 min. 99344 high severity problem, 60 min. 99345 patient unstable or significant new problem requiring immediate attention 75 min.

Codes for Established Patients

93347 Self-limited or minor problem, 15 min. 99348 Low to moderate problem, 25 min. 99349 Moderate to high problem, 40 min. 99350 Patient unstable or significant new problem requiring immediate physician attention, 60 min.

If other services such as advanced care planning, diagnostic services, and some minor procedures are performed, they can be documented and billed in addition to the visit code in this setting.

Demographics, Insurance, and Billing Information

As the home visit with a new patient has the same business requirements as a visit to the office, AAPC says that maintaining a complete and accurate medical record for each patient is critical. Physicians should gather the necessary demographic and insurance information and provide patients with the appropriate forms such as Notice of Privacy Practices, general consent for treatment, new patient intake form, history form, and financial policies.

OSI’s experienced billing and coding professionals can handle all of your billing and coding needs efficiently.

Get in touch with us at (800) 670 2809 now to get started!

Billing for Physician Home Visits – Risk Factors

DC based Law Firm Liles Parker lists the risk factors that can lead Medicare reviewers to deny claim payment:

• If it appears that one or more of the home services were was conducted for the convenience of the patient, the patient’s family, or the physician
• The documentation does not prove that the patient was not able come to the physician’s office or an outpatient clinic for care.
• The medical record does not clearly show that the patient, his/her family or another clinician involved in the case sought the initial service
• The home services are provided at a frequency that exceeds that which is typically provided in the office and acceptable standards of medical practice
• The physician does not personally provide the home services. The service is performed by a non-physician practitioner (NPP) but the claim is being billed at the physician’s rate.
• The home services are solely provided by an NPP but only the physician, not the treating NPP, is credentialed with Medicare.
• The specific home services performed could be provided by a visiting nurse or home health agency.

With OIG and many CMS contractors auditing home services (CPT codes 99341 through 99350) billed to Medicare, participating physicians should understand the coverage and billing requirements. The documentation should provide clear proof of medical necessity. Other services such as minor procedures or advanced care planning services can also be rendered in a variety of living situations and providers should be familiar with the specifics to each code location. It is important that physicians review all the relevant CPT codes with their medical billing company . Partnering with an experienced medical billing and coding service provider can help home-based primary care practices achieve savings while delivering holistic, team-based care to old, sick, frail, or functionally limited people.

Rajeev Rajagopal, the President of OSI, has a wealth of experience as a healthcare business consultant in the United States. He has a keen understanding of current medical billing and coding standards.

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CPT Codes For Home Visit Services

Below is a list summarizing the CPT codes for home visit services.

CPT Code 99500

CPT 99500 describes a home visit for prenatal monitoring and assessment, including fetal heart rate, non-stress test, uterine monitoring, and gestational diabetes monitoring.

CPT Code 99501

CPT 99501 describes a home visit for postnatal assessment and follow-up care.

CPT Code 99502

CPT 99502 describes a home visit for newborn care and assessment.

CPT Code 99503

CPT 99503 describes a home visit for respiratory therapy care, such as a bronchodilator, oxygen therapy, respiratory assessment, and apnea evaluation.

CPT Code 99504

CPT 99504 describes a home visit for mechanical ventilation care.

CPT Code 99505

CPT 99505 describes a home visit for stoma care and maintenance, including colostomy and cystostomy.

CPT Code 99506

CPT 99506 describes a home visit for intramuscular injections.

CPT Code 99507

CPT 99507 describes a home visit for care and maintenance of catheter(s) such as urinary, drainage, and enteral.

CPT Code 99509

CPT 99509 describes a home visit for assistance with activities of daily living and personal care.

CPT Code 99510

CPT 99510 describes a home visit for individual, family, or marriage counseling.

CPT Code 99511

CPT 99511 describes a home visit for fecal impaction management and enema administration.

CPT Code 99512

CPT 99512 describes a home visit for hemodialysis.

CPT Code 99600

CPT 99600 describes an unlisted home visit service or procedure.

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Home Care and Domiciliary Care Visits (Codes 99321 - 99350)

Guidance for the updates to §30.6.14 in Chapter 12, Pub. 100-04, by adding place of service codes (POS) 13 (assisted living facility) and 14 (group home) to be included with the CPT Domiciliary, Rest Home (e.g., Boarding Home), or Custodial Care Services codes.

Download the Guidance Document

Issued by: Centers for Medicare & Medicaid Services (CMS)

Issue Date: September 02, 2005

DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.

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List of CPT/HCPCS Codes

We maintain and annually update a List of Current Procedural Terminology (CPT)/Healthcare Common Procedure Coding System (HCPCS) Codes (the Code List), which identifies all the items and services included within certain designated health services (DHS) categories or that may qualify for certain exceptions. We update the Code List to conform to the most recent publications of CPT and HCPCS codes and to account for changes in Medicare coverage and payment policies. Code List updates for years 2022 and earlier were published in the Federal Register as an addendum to the annual Physician Fee Schedule final rule. 

Beginning with the Code List effective January 1, 2023, updates are published solely on this webpage.  On or before December 2 nd of each year, we will publish the annual update to the Code List and provide a 30-day public comment period using www.regulations.gov . To be considered, comments must be received within the stated 30-day timeframe. We anticipate that most comments will be addressed by April 1 st ; however, a longer timeframe may be necessary to address complex comments or those that require coordination with external parties. If no comments are received, in lieu of a comment response, we will publish a note below the applicable Code List year stating so. 

2024 Annual Update to the Code List

Below you will find the Calendar Year (CY) 2024 Code List published November 29, 2023 and a description of the revisions for CY 2024, our response to comments on that Code List, and the updated CY 2024 Code List, which is effective January 1, 2024 unless otherwise indicated on the Code List.

• UPDATED list of codes effective January 1, 2024, published March 1, 2024 (all codes effective January 1, 2024 unless otherwise indicated on the Code List) (ZIP)
• List of codes effective January 1, 2024, published November 29, 2023 (ZIP)
• Annual Update to the List of CPT/HCPCS Codes Effective January 1, 2024 (PDF)

We received one comment related to the additions, deletions, and corrections to the codes on the Code List effective January 1, 2024. Our response to this comment is below. We also received one comment related to Medicare coverage for platelet-rich plasma treatments. We consider this comment to be outside the scope of the annual update. CMS does not respond to out of scope comments on the annual updates to the Code List. 

Comment : One commenter noted that, although most Hepatitis B vaccine codes are identified on the Code List as CPT/HCPCS codes to which the exception for preventive screening tests and vaccines at § 411.355(h) applies, the Hepatitis B vaccine associated with CPT code 90739 was not listed. The commenter requested that CPT code 90739 be added to the list of vaccine codes to which the exception for preventive screening tests and vaccines at §411.355(h) applies, effective retroactively to January 1, 2024.

Response : We agree with the commenter that the exception for preventive screening tests and vaccines at § 411.355(h) should apply to CPT code 90739 and are revising the Code List accordingly. The applicability of the exception for preventive screening tests and vaccines to CPT code 90739 is prospective only and effective on the date indicated on the UPDATED list of codes. 

In considering this comment, we also identified two CPT codes (90653 and 90658, both flu vaccines) that were inadvertently left off of the list of codes to which the exception for preventive screening tests and vaccines at § 411.355(h) should apply. Accordingly, we are adding these CPT codes to the list of codes to which the exception at § 411.355(h) applies, effective on the date indicated on the UPDATED list of codes.

2023 Annual Update to the Code List

Below you will find the Code List that is effective January 1, 2023 and a description of the revisions effective for Calendar Year 2023. 

• List of codes effective January 1, 2023, published December 1, 2022
• Annual Update to the List of CPT/HCPCS Codes Effective January 1, 2023, published December 1, 2022 (PDF)

The comment period ended December 30, 2022. We did not receive any comments related to the additions, deletions, and corrections to the codes on the Code List effective January 1, 2023. We received one (1) comment related to the supervision level required for specific services. We consider this comment to be outside the scope of the annual update. CMS does not respond to out of scope comments on the annual updates to the Code List. 

DHS Categories

The DHS categories defined by the Code List are:

• clinical laboratory services;
• physical therapy services, occupational therapy services, outpatient speech-language pathology services;
• radiology and certain other imaging services; and
• radiation therapy services and supplies.

The Code List also identifies those items and services that may qualify for either of the following two exceptions to the physician self-referral prohibitions: 

• EPO and other dialysis-related drugs (42 CFR § 411.355(g)).
• Preventive screening tests and vaccines (42 CFR § 411.355(h)).

NOTE: The following DHS categories are defined at 42 CFR §411.351 without reference to the Code List:

• durable medical equipment and supplies;
• parenteral and enteral nutrients, equipment and supplies;
• prosthetics, orthotics, and prosthetic devices and supplies;
• home health services;
• outpatient prescription drugs; and
• inpatient and outpatient hospital services.

Related Links

• List of codes effective January 1, 2022, published November 19, 2021
• List of codes effective January 1, 2021, issued December 1, 2020
• List of codes effective January 1, 2020, published December 2, 2019
• List of codes effective January 1, 2019, published November 23, 2018
• List of codes effective January 1, 2018, published November 3, 2017 [ZIP, 59KB]
• List of codes effective January 1, 2017, published November 16, 2016 [ZIP, 54KB]
• List of codes effective January 1, 2016, published October 30, 2015 [ZIP, 58KB]
• List of codes effective January 1, 2015, published November 13, 2014 (79 FR 67972) [ZIP, 54KB]
• List of codes effective January 1, 2014, published December 10, 2013 (78 FR 74791) [ZIP, 54KB]
• List of codes effective January 1, 2013, published November 16, 2012 (77 FR 69334) [ZIP, 54KB]