2025 CPT code 99344
(Active) 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; moderate medical decision-making or 60+ minutes total time.
Modifiers may be applicable depending on the circumstances of the visit (e.g., modifier 25 for a significant, separately identifiable E/M service performed on the same day as another procedure, modifier 99 for multiple modifiers).
Medical necessity is established when the patient's condition requires a home visit due to their inability to travel to the physician's office, such as advanced age, severe illness, or disability.The complexity of the patient's condition must justify the level of service provided as documented in the clinical record.
The physician performs a comprehensive assessment and management of the new patient's condition, including history taking (if needed), physical examination (if needed), ordering and reviewing tests, developing a treatment plan, and coordinating care with other healthcare professionals as needed. The level of complexity of the medical decision-making or the total time spent on the encounter dictates the choice of the code.The physician is responsible for documenting all aspects of the encounter in the medical record.
In simple words: The doctor visits a new patient at home or in a similar setting (like an assisted living facility).The visit takes at least 60 minutes or involves a moderately complex medical issue.
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 a moderate level of medical decision-making (MDM) or a total time of at least 60 minutes on the date of the encounter.Total time includes face-to-face and non-face-to-face activities (excluding travel time). Examples include reviewing tests, performing the exam, counseling, ordering tests, communicating with other providers, documenting the encounter, and coordinating care.The history and examination components are medically appropriate but do not determine the code selection; only MDM level or total time dictates the code choice.
Example 1: A 78-year-old new patient with congestive heart failure experiences worsening shortness of breath. The physician performs a home visit, including a thorough history, physical exam, review of recent labs, adjustment of medications, and education for the patient and caregiver. The total time spent is 75 minutes., A 65-year-old new patient with newly diagnosed type 2 diabetes requires extensive education on managing their blood sugar levels and diet. The physician spends 60 minutes at the patient's home discussing their condition and answering their questions., An 80-year-old new patient who recently had a stroke requires ongoing assessment of mobility and potential complications.The physician conducts a physical exam at the patient’s home, reviews the patient’s recovery progress, makes adjustments to the plan of care, and schedules a follow up visit.The level of medical decision-making involved is moderate.
Detailed documentation of the encounter is required. This includes a thorough history (if performed), physical examination findings (if performed), assessment and plan, results of any diagnostic testing, education provided, and any care coordination activities.Documentation must justify the level of medical decision making or total time spent.
** Travel time is not included in the total time calculation.The code should only be used for new patients.
- Payment Status: Active
- Specialties:Geriatrics, Internal Medicine, Family Medicine, Cardiology, Neurology, 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