2025 CPT code 99306
(Active) Effective Date: N/A Revision Date: N/A Evaluation and Management - Nursing Facility Services Feed
Initial nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 50 minutes must be met or exceeded.
Modifiers may be applicable to 99306. For instance, modifier 25 may be appended if a significant, separately identifiable E/M service is performed on the same day as another procedure or service.
Medical necessity for 99306 must be supported by the patient's condition and the complexity of the medical decision-making required for the encounter. The documentation must clearly show why the extended time or high level of MDM was necessary.
The provider performs an evaluation and management (E/M) service for a patient in the nursing facility setting. This is an initial service.The total time spent on the date of the encounter is at least 50 minutes, and/or the level of medical decision making (MDM) involved is high. Total time includes both face-to-face and non-face-to-face activities on the encounter date. Examples include, but are not limited to, reviewing tests and otherwise preparing for the patient visit, performing the exam or evaluation, counseling and educating the patient or caregiver, ordering tests, communicating with other healthcare providers, documenting the encounter, interpreting and communicating results, and coordinating care.
In simple words: The provider sees a patient for an initial nursing facility care visit involving evaluation and management (E/M). The visit involves high medical decision making, and/or the provider spends at least 50 minutes of total time on the encounter on a single date.
Initial nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 50 minutes must be met or exceeded. (For services 65 minutes or longer, use prolonged services code 99418)
Example 1: A new patient is admitted to a skilled nursing facility following a hip replacement. The physician spends 55 minutes conducting a comprehensive history and physical exam, assessing the patient's post-surgical condition, pain management, and mobility, and formulating a care plan. This encounter would be coded as 99306., An established patient in a nursing facility experiences a sudden onset of shortness of breath and chest pain. The physician spends 50 minutes evaluating the patient, including reviewing diagnostic tests, consulting with a cardiologist, and adjusting medications. The MDM is high due to the acute nature of the problem and potential for serious complications. This encounter is coded as 99306., A patient with multiple chronic conditions, including diabetes, heart failure, and dementia, is admitted to a nursing facility. The physician spends 60 minutes evaluating the patient's overall health status, reviewing lab results, medication reconciliation, and coordinating care with other specialists. The time spent and the complexity of the patient's conditions warrant the use of 99306. For the additional 10 minutes beyond the 50-minute threshold for 99306, prolonged services codes may be applicable; for example, +99418.
Documentation must support the level of service billed. This includes a detailed history, a medically appropriate physical exam, and documentation of the high level of MDM or total time spent. If time is used to determine the code, both face-to-face and non-face-to-face time related to the encounter must be documented.
- Specialties:Internal Medicine, Family Medicine, Geriatrics, and other specialties providing care in nursing facilities.
- Place of Service:Skilled Nursing Facility, Nursing Facility