2025 CPT code 99316
(Revised) Effective Date: N/A Revision Date: N/A Evaluation and Management - Nursing Facility Services Evaluation and Management Feed
Nursing facility discharge management; more than 30 minutes total time on the date of the encounter.
Modifiers may apply depending on the circumstances of the service. Consult the most up-to-date CPT guidelines for specific modifier usage.
Medical necessity is established when the patient requires comprehensive discharge planning services due to complex medical needs, multiple comorbidities, or significant functional limitations. The services must be reasonable and necessary for the patient's safe and effective transition to the next level of care.
The physician or other qualified healthcare professional is responsible for performing a comprehensive assessment of the patient's condition, reviewing their nursing facility stay, developing a discharge plan, providing instructions to caregivers, and preparing necessary documentation for the patient's transition to the next care setting.
In simple words: This code is used when a doctor or other healthcare professional spends more than 30 minutes helping a patient leave a nursing home. This includes things like a final checkup, talking about their stay, giving instructions to family members, and preparing paperwork for their discharge.
This CPT code reports nursing facility discharge management services requiring more than 30 minutes of total time on the date of the face-to-face encounter with the patient and/or family/caregiver.The encounter may occur before the patient's actual departure from the facility.Services include a final patient examination, discussion of the nursing facility stay, instructions for continuing care to caregivers, and preparation of discharge records, prescriptions, and referral forms.The total time spent on the encounter date, whether continuous or not, determines code selection.
Example 1: A 78-year-old patient with multiple comorbidities is being discharged from a nursing facility after a 3-week stay for rehabilitation following a stroke. The physician spends 45 minutes reviewing the patient's progress, discussing the discharge plan with the patient and family, providing medication instructions, and arranging for home healthcare services. Code 99316 is appropriate., An 85-year-old patient with dementia is discharged from a nursing facility. The physician spends over an hour coordinating the transfer to an assisted living facility, reviewing the patient's medical history with the new facility's staff, and addressing any concerns with the family regarding the patient's care needs. Code 99316 applies., A 67-year-old patient recovering from a hip replacement is discharged from a nursing facility after a 2-week stay.The physician spends 35 minutes coordinating the discharge, discussing follow-up appointments, and reviewing the patient's medications with family members.Code 99316 would be used.
Detailed documentation is required including:
** The total time spent on the encounter date must exceed 30 minutes for code 99316 to be appropriate.The time does not need to be continuous; multiple shorter interactions throughout the day can add up to over 30 minutes.Always ensure that the level of service provided justifies the billing of this code.
- Revenue Code: M4B (Nursing Home Visit)
- RVU: This information is not available in the provided sources and would require accessing a current Relative Value Unit (RVU) database.
- Global Days: The provided sources do not specify a global period for this code.Further research into current CPT guidelines is recommended.
- Payment Status: Active
- Modifier TC rule: The provided sources do not offer information on the Technical Component (TC) modifier for this code. Consult current CPT guidelines.
- Fee Schedule: Historical fee schedule data is not available in the sources.Consult a fee schedule database for this information.
- Specialties:Geriatric medicine, family medicine, internal medicine, rehabilitation medicine
- Place of Service:Nursing Facility, Office