Evaluation & management · General
Home or residence visit for an established patient with high medical decision making or at least 60 minutes of total time.
- Medicare
- $193.06
- Work RVU
- 3.6
- 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 high 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 ↓
99350 reports a visit to an established patient at their home or residence, including assisted living and group homes, with high 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.
High MDM at home usually means a serious change, like a fall with suspected periprosthetic fracture where the visit decides on emergency transfer.
Medicare does not require the patient to be homebound. Place of service 12, 13, or 14 should match where the patient lives. A related visit inside a surgical global stays bundled, even when the problem is serious.
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 (3.6) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (5.78) adds practice overhead and malpractice, and is what drives the Medicare payment below.
| Work RVU | 3.6 |
| Practice expense RVU | 1.94 |
| Malpractice RVU | 0.24 |
| Total RVU | 5.78 |
| Medicare national rate | $193.06 |
| 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 | $193.06 |
Common denial reasons
The recurring reasons claims for CPT 99350 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 ↓
01When should 99350 be used?
02Can 99350 be billed with modifier 57?
03Why was 99350 downcoded?
Sources & references
Editorial content was developed using the following public sources.
Mira Scribe
Mira Scribe writes up the severity, the decision about transfer, and who was contacted, which backs a high MDM home visit.
See how Mira captures CPT 99350 documentation