2025 CPT code 99350
(Active) Effective Date: N/A Revision Date: N/A Evaluation and Management - Home or Residence Services Feed
Home or residence visit for the evaluation and management of an established patient requiring a medically appropriate history and/or examination with a high level of medical decision making, or at least 60 minutes of total time spent on the date of the encounter.
Modifiers may be applicable. Common modifiers include -24 (Unrelated E/M Service During a Postoperative Period), -25 (Significant, Separately Identifiable E/M Service on the Same Day of the Procedure or Other Service), and -57 (Decision for Surgery).
Medical necessity must be established for all services billed. The documentation should clearly support the need for a home visit, the complexity of the patient’s condition, and the intensity of services provided.
The physician is responsible for providing a medically appropriate history and/or physical examination, evaluating the patient's condition, making treatment decisions, counseling and educating the patient/caregiver, ordering tests, communicating with other healthcare providers, documenting the encounter, and coordinating care as needed.
In simple words: The doctor visited an established patient at their home or residence. The visit involved complex medical decision-making or took at least 60 minutes of the doctor's time on that day. This time includes preparing for the visit, the actual visit itself, and any follow-up work, but not travel time. The doctor may have examined the patient, talked to them about their health, and made decisions about their care.
This code represents a visit to a patient's home or residence (including private residences, temporary lodging, assisted living facilities, group homes, custodial care facilities, and residential substance abuse treatment facilities) for the evaluation and management of an established patient. The visit includes a medically appropriate history and/or examination. The code is chosen based on either a high level of medical decision making (MDM) or when the total time spent on the date of the encounter is 60 minutes or more. Time includes both face-to-face and non-face-to-face activities related to the encounter (e.g., reviewing tests, preparing for the visit, counseling, documenting, communicating with other healthcare providers, coordinating care), but excludes travel time. For services 75 minutes or longer, prolonged services code 99417 may be applicable.
Example 1: A physician visits an established patient with congestive heart failure at their assisted living facility to assess their condition, adjust medications, and coordinate care with the facility staff. The visit takes 65 minutes., A physician visits an established patient at home to manage their complex wound care following surgery. The MDM is high due to the risk of infection and complications. The visit takes 45 minutes., A physician visits a patient residing in a residential substance abuse treatment facility to address a new medical concern, requiring a thorough evaluation and decision-making regarding potential interactions with current medications. The visit takes 70 minutes.
Documentation should include the location of the visit, the reason for the visit, relevant history and physical exam findings, MDM elements (number and complexity of problems, data reviewed, risk), total time spent on the date of encounter, and any procedures performed. Documentation must support the level of service billed.
- Specialties:Internal Medicine, Family Medicine, Geriatrics, Home Health
- Place of Service:Home, Assisted Living Facility, Group Home, Custodial Care Facility, Residential Substance Abuse Treatment Facility, Temporary Lodging