2025 CPT code 99341

Home or residence visit for a new patient; straightforward medical decision making or at least 15 minutes of total time.

Follow all applicable CPT guidelines for Evaluation and Management services.Accurate documentation of time spent and level of medical decision-making is crucial for proper code selection.

Modifiers may apply depending on the circumstances of the visit (e.g., 25 for a significant separately identifiable E/M service,99 for multiple modifiers).

The service is medically necessary when a home visit is required due to the patient's medical condition or inability to travel to the physician's office.Justification should be documented in the medical record.

The physician performs a comprehensive assessment, develops a plan of care, orders and interprets tests, communicates with other healthcare providers as needed, and documents the visit.

IMPORTANT Related codes include 99342, 99344, and 99345 (for subsequent visits to the same patient), and other E/M codes depending on the complexity of the visit.

In simple words: The doctor makes a house call to see a new patient. The visit includes a medical checkup and discussion, and either the medical decision-making is straightforward, or the doctor spends at least 15 minutes with the patient.

This CPT code reports an evaluation and management (E/M) service for a new patient in their home or residence.This includes private residences, temporary lodging, assisted living facilities, group homes (excluding those licensed as intermediate care facilities for individuals with intellectual disabilities), custodial care facilities, or residential substance abuse treatment facilities.The service requires either straightforward medical decision-making or a total time of at least 15 minutes on the date of the encounter.Total time includes face-to-face and non-face-to-face activities (excluding travel time) such as reviewing tests, performing the exam, counseling, ordering tests, communicating with other providers, documenting, interpreting results, and coordinating care. A medically appropriate history and/or physical examination may be included, determined by the provider's clinical judgment.The level of history and exam does not influence code selection.

Example 1: A 78-year-old patient with newly diagnosed congestive heart failure is seen at home for initial evaluation and medication education. The physician spends 20 minutes in total, including physical examination and patient/family teaching., A 65-year-old patient with a new diagnosis of Type II diabetes is seen at home.The physician reviews lab results, discusses dietary changes and exercise, and initiates a medication plan. The total time involved is 18 minutes. , A new patient in an assisted living facility requires an initial assessment for wound care. The physician evaluates the wound, discusses treatment options with the patient and staff, and orders appropriate tests. The visit involves straightforward MDM, taking less than 15 minutes.

Detailed history of the present illness, including onset, character, duration, and associated symptoms. Review of systems.Past medical history, including medications, allergies, and prior hospitalizations.Physical examination findings.Assessment and plan, including diagnosis, treatment plan, and follow-up instructions.Documentation of time spent on the visit.

** Travel time is not included in the total time calculation.Code 99343 was deleted effective January 1, 2023.

  • Payment Status: Active
  • Specialties:Family Medicine, Internal Medicine, Geriatrics, Cardiology, and other specialties depending on the patient's condition.
  • Place of Service:Home, Assisted Living Facility, Group Home, Custodial Care Facility, Residential Substance Abuse Treatment Facility, Temporary Lodging
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