These codes apply to patients seen in their own homes, a group home, homeless shelter, assisted living, or residential substance-abuse facility. It doesn't apply to places with skilled nursing care, such as nursing home facilities, intermediate care facilities for persons with intellectual disabilities, or psychiatric residential treatment facilities.
As with other outpatient visits, these visits are coded based on whether the patient is New or Established, and are coded based on either Medical Decision-Making or Time. MDM is based on the same rules as routine office visits. Note that “level 3” code for new patients (99343) was deleted; similarly there are also only 4 total levels for established patients.
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New
|
MDM
|
Time
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Established
|
MDM
|
Time
|
|
99341
|
Straightforward
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≥ 15 minutes
|
99347
|
Straightforward
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≥ 20 minutes
|
|
99342
|
Low
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≥ 30 minutes
|
99348
|
Low
|
≥ 30 minutes
|
|
99344
|
Moderate
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≥ 60 minutes
|
99349
|
Moderate
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≥ 40 minutes
|
|
99345
|
High
|
≥ 75 minutes
|
99350
|
High
|
≥ 60 minutes
|
For non-Medicare patients, if the time exceeds the 99345 or 99350 minimum by more than 15 minutes, prolonged services (99417) can be reported in addition to these codes. For Medicare patients alone, G0318 can be added in addition to these codes but requires ≥ 140 minutes for 99345, or ≥ 110 minutes for 99350. Note that G0318 involves work within three days prior to and up to 7 days after the home visit. Nursing Home Visits are covered in the inpatient portion of this Unit.