2025 CPT code 99342
(Revised) Effective Date: N/A Revision Date: N/A Evaluation and Management - Home or Residence Services Evaluation and Management Feed
Home or residence visit for a new patient; low medical decision making or at least 30 minutes of total time spent.
Modifiers may apply depending on the circumstances of the visit.For example, modifier 25 might be used if a significant, separately identifiable E/M service was performed on the same day as another procedure.Consult the CPT modifier guidelines for appropriate usage.
The home visit must be medically necessary due to the patient's condition or inability to travel to the office.This should be clearly documented.Factors such as limited mobility, severe illness, or post-operative recovery could support the medical necessity.
The physician performs a comprehensive assessment of the patient's condition, orders and interprets tests as needed, develops a treatment plan, and provides education and counseling to the patient and/or family.Coordination of care with other healthcare professionals may also be involved.
In simple words: The doctor makes a first-time visit to a patient's home (including places like assisted living facilities or group homes) to check on their health.The visit takes at least 30 minutes or involves a simple medical problem.
This CPT code reports an evaluation and management (E/M) service provided to a new patient in their home or residence.The visit includes a medically appropriate history and/or examination, with the level of service determined by either the level of medical decision-making (MDM) or the total time spent.For code 99342, the MDM must be low, or the total time spent on the encounter date must be at least 30 minutes.Total time includes face-to-face and non-face-to-face time, excluding travel time.Examples of included activities are reviewing tests, performing the exam, patient/caregiver education, ordering tests, communicating with other providers, documentation, result interpretation, and care coordination.The home or residence may be a private residence, temporary lodging, assisted living facility, group home (excluding those licensed as intermediate care facilities for intellectual disabilities), custodial care facility, or residential substance abuse treatment facility.
Example 1: A 78-year-old patient with newly diagnosed congestive heart failure is seen at home for initial assessment and education on medication management and lifestyle modifications.The visit takes 45 minutes., A 65-year-old patient recently discharged from the hospital after a stroke is visited at home for a follow-up visit to assess their recovery progress, adjust medications, and coordinate care with physical therapy., A 22-year-old patient with a complex psychiatric condition is seen at their residential treatment facility for an initial assessment, which includes a thorough history and mental status exam.The physician reviews previous records, consults with other treating professionals, and begins a treatment plan.
Detailed documentation of the history, physical exam, MDM, and total time spent should be included in the medical record.This should support the medical necessity of the visit and the chosen code level. Any consultations with other providers, tests ordered, and care coordination activities must also be documented.
** Travel time is not included in the total time calculation.The code is for new patients only.Consider using other EM codes (99350, etc.) if the patient is established and the complexity requires a higher level of service.
- Payment Status: Active
- Modifier TC rule: A Technical Component (TC) modifier does not apply to this code.
- Specialties:Family Medicine, Internal Medicine, Geriatrics, Cardiology, Neurology, Psychiatry
- Place of Service:Home, Assisted Living Facility, Group Home, Custodial Care Facility, Residential Substance Abuse Treatment Facility