Evaluation & management · General
Home or residence visit for an established patient with straightforward medical decision making or at least 20 minutes of total time.
- Medicare
- $46.09
- Work RVU
- 0.9
- 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 straightforward MDM, or at least 20 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 ↓
99347 reports a visit to an established patient at their home or residence, including assisted living and group homes, with straightforward decision making or at least 20 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.
In ortho or PM&R practice this fits a quick follow-up at home for a stable issue, like a cast or brace check for a patient who cannot travel, outside any global period.
Medicare does not require the patient to be homebound. Use place of service 12 for a private home, 13 for assisted living, 14 for a group home. Postop checks during a global are still included in the surgery, even when done at home.
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 (0.9) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (1.38) adds practice overhead and malpractice, and is what drives the Medicare payment below.
| Work RVU | 0.9 |
| Practice expense RVU | 0.44 |
| Malpractice RVU | 0.04 |
| Total RVU | 1.38 |
| Medicare national rate | $46.09 |
| 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 | $46.09 |
Common denial reasons
The recurring reasons claims for CPT 99347 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 is CPT 99347?
02Can a cast check at home be billed as 99347?
03What place of service goes with 99347?
Sources & references
Editorial content was developed using the following public sources.
Mira Scribe
Mira Scribe keeps short home follow-ups clean: setting, findings, plan, and whether the visit falls outside any global.
See how Mira captures CPT 99347 documentation