Evaluation & management · General
Home or residence visit for a new patient with moderate medical decision making or at least 60 minutes of total time.
- Medicare
- $146.63
- Work RVU
- 2.87
- Global, days
- Region
- General
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 3 cited references ↓
- Place of residence (home, assisted living, group home) and matching place of service code
- Reason for seeing the patient at the residence (not a Medicare requirement, but payers and auditors ask)
- History and exam relevant to the complaint
- Assessment and plan supporting moderate MDM, or at least 60 minutes of total time
- Coordination with home health or caregivers, if any
Applicable modifiers
Modifiers commonly billed with this code.
Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual
What this code covers
Source · Editorial summary grounded in 3 cited references ↓
99344 reports a visit to a new patient at their home or residence, including assisted living and group homes, with moderate decision making or at least 60 minutes of total time. Since 2023 the home and domiciliary codes are combined, so the same codes are used for a private home and an assisted living facility.
This level fits a new problem with real treatment decisions, such as evaluating an assisted living resident for a suspected insufficiency fracture and deciding on imaging and weight-bearing. There is no 99343; it was deleted in 2023.
Place of service drives a lot of these denials. Use 12 for a private home, 13 for assisted living, 14 for a group home. Skilled nursing and nursing facility residents are a different code family (99304 to 99310), so do not bill home codes there. Postop checks during a global are still part of the surgery.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
Work RVU vs. total RVU
The work RVU (2.87) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (4.39) adds practice overhead and malpractice, and is what drives the Medicare payment below.
| Work RVU | 2.87 |
| Practice expense RVU | 1.36 |
| Malpractice RVU | 0.16 |
| Total RVU | 4.39 |
| Medicare national rate | $146.63 |
| Global period | days |
Payment by site of service
Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.
Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026
| Setting | Medicare rate (national) |
|---|---|
Office (PFS non-facility) Procedure performed in physician's office | $146.63 |
Common denial reasons
The recurring reasons claims for CPT 99344 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Place of service does not match a home or residence setting
- Postop visit inside a surgical global period
- MDM or time does not support the level billed
- New patient code used for a patient seen in the office within three years
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 3 cited references ↓
01What happened to CPT 99343?
02What time is required for 99344?
03Can an orthopedic surgeon bill 99344?
Sources & references
Editorial content was developed using the following public sources.
Mira Scribe
Mira Scribe captures the new problem, the tests ordered, and the treatment decision, which is what supports moderate MDM on a home visit.
See how Mira captures CPT 99344 documentation