2025 CPT code 99304
(Revised) Effective Date: N/A Revision Date: N/A Evaluation and Management - Nursing Facility Services Evaluation and Management Services Feed
Initial nursing facility care, per day, requiring a medically appropriate history and/or examination and straightforward or low level of medical decision making. Total time must be at least 25 minutes when using time for code selection.
Modifiers may be applicable, for instance, modifier 25 can be used to indicate a significant, separately identifiable E/M service on the same day as another service.
Medical necessity must be established for the services provided.The documentation must support the reason for the encounter and the services provided.
The provider performs an evaluation and management (E/M) service for a patient in a nursing facility setting. This is an initial service. The total time spent on the date of the encounter is at least 25 minutes or the level of medical decision making (MDM) involved is straightforward or low.
In simple words: The provider sees a patient for an initial nursing facility care visit.This involves a straightforward medical decision-making process or at least 25 minutes of the provider's time on the same day.
Initial nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward or low level of medical decision making. When using total time on the date of the encounter for code selection, 25 minutes must be met or exceeded.
Example 1: A new patient is admitted to a skilled nursing facility following a hospitalization for a hip fracture. The physician performs an initial evaluation, which involves a straightforward medical decision-making process, taking about 25 minutes., A patient residing in a nursing facility develops a new urinary tract infection. The physician performs an initial evaluation and management service, requiring straightforward medical decision making., A specialist, such as a cardiologist, sees a new patient in a nursing facility for the initial evaluation of their congestive heart failure. The specialist’s visit takes 25 minutes and involves straightforward or low medical decision making.
Documentation should support the level of MDM or the total time spent, including a medically appropriate history and/or physical exam.Details about the number and complexity of problems addressed; the amount and/or complexity of data reviewed; and the risk of complications should be clearly documented.
- Global Days : This code represents an initial visit and does not have global days associated with it.
- Specialties:Internal Medicine, Family Medicine, Geriatrics and other specialties may use this code depending on the circumstances.
- Place of Service:Skilled Nursing Facility, Nursing Facility