cpt codes for home visit

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

• Chronic care
• Medicare/Medicaid
• Physician compensation
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• Reimbursement
• Value-based payment

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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 .

Copyright © 2024 American Academy of Family Physicians. All Rights Reserved.

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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• Conveyor QR
• Conveyor USB

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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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