2025 CPT code 99310
(Revised) Effective Date: N/A Revision Date: N/A Evaluation and Management - Nursing Facility Services Feed
Subsequent 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, 45 minutes must be met or exceeded.
Modifiers may be applicable to 99310 to indicate specific circumstances, such as unrelated E/M services during a postoperative period (modifier 24), or significant, separately identifiable E/M services on the same day as a procedure (modifier 25).
Medical necessity for 99310 must be supported by the documentation. The services provided must be reasonable and necessary for the diagnosis or treatment of the patient's condition.
The provider performs a subsequent evaluation and management (E/M) service for a patient in a nursing facility.The visit requires either a high level of medical decision making or at least 45 minutes of total time spent by the provider.
In simple words: The provider sees a patient for a follow-up visit at a nursing facility. The visit requires either complex medical decision-making or at least 45 minutes of the provider's time (including time spent with the patient and on related tasks like reviewing tests and charting).
This code represents a subsequent nursing facility care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making (MDM) or the provider spends at least 45 minutes of total time on the encounter on a single date.The total time includes both face-to-face and non-face-to-face activities on the encounter date. Examples include reviewing tests, preparing for the patient visit, performing the exam, counseling and educating the patient/caregiver, ordering tests, communicating with other healthcare providers, documenting the encounter, interpreting and communicating results, and coordinating care. MDM elements include the number and complexity of problems addressed; the amount and complexity of data reviewed; and the risk of complications and mortality.
Example 1: A patient in a nursing facility with multiple chronic conditions, such as diabetes, heart failure, and chronic kidney disease, experiences a sudden change in mental status. The physician spends over 45 minutes evaluating the patient, reviewing lab results, and consulting with specialists to determine the cause and develop a treatment plan. Code 99310 is appropriate due to the time spent., A nursing facility resident with advanced dementia develops a new infection. The physician assesses the patient, reviews their medical history, orders tests, and prescribes antibiotics.The physician spends 30 minutes with the patient and another 20 minutes reviewing test results and coordinating care with the nursing staff. Code 99310 is appropriate due to the total time exceeding 45 minutes. , A patient with a recent hip fracture is recovering in a nursing facility. The physician performs a follow-up evaluation, noting slow progress in physical therapy. The physician spends 30 minutes with the patient, discussing treatment options, and another 15 minutes adjusting medications and ordering additional tests. Code 99310 would be used due to the complexity of the medical decision making and the total time spent.
Documentation should support the level of MDM or total time spent.This includes details about the patient's condition, the complexity of the problem(s) addressed, the amount and complexity of data reviewed, the risk of complications, and the total time spent on the date of the encounter, including both face-to-face and non-face-to-face time.
** For prolonged services of 60 minutes or more, use code 99418 in conjunction with 99310. Prolonged service time should be documented in the record.
- Specialties:Typically used by physicians specializing in geriatrics, internal medicine, family medicine, or other specialties providing care in nursing facilities.
- Place of Service:Nursing Facility