Nursing care facilities look simple. However, they are actually one of the most medically complex because the staff has to deal with patients with all sorts of medical issues related to different specialties. A common problem in these settings is how to bill follow-up visits.
One of the codes used to bill these visits is CPT code 99307. The code itself represents a simple subsequent visit, but billing it can be tricky due to numerous requirements. We have created this guide to simplify these complexities for you. So, let’s start.
CPT Code 99307 – Description
CPT code 99307 is defined as:
“Subsequent nursing facility care, per day, for the evaluation and management of a patient, 10 minutes must be met or exceeded.”
Let’s break this down in detail. As evident from the definition, 99307 is an evaluation and management (E/M) code for nursing care. It applies to follow-up visits with established patients in a skilled nursing facility (SNF) or other long-term care settings. However, the important point to note is that it is only for a follow-up visit. It does not include any major decision-making, diagnosis, or complex adjustment of medication.
This code can be selected for two reasons: medical decision-making (MDM) complexity or total time of the session. MDM must be at the straightforward level, or the time of the session must be at least 10 minutes. Please note that the total time includes both face-to-face and non-face-to-face activities.
Basically, 99307 is part of a 4-code family. Here’s the comparison of these codes:
| CPT Code | MDM Level | Typical Time | Clinical Context |
|---|---|---|---|
| 99307 | Straightforward | 10 min | Stable, no care plan changes. |
| 99308 | Low | 15-20min | Minor changes to the care plan. |
| 99309 | Moderate | 30-44 min | New problems or worsening condition |
| 99310 | High | 45+ min | Multiple morbidities, intensive management |
Scenarios Where CPT Code 99307 is Applicable
Here are a couple of real-world scenarios in which CPT code 99307 can be used:
Post-Surgical Recovery Monitoring
Suppose a patient recently had a hip replacement surgery. This is a major surgery, so he also needs skilled nursing care. The care is ongoing, and during one subsequent visit, the physician reviewed the nursing notes and, based on the notes and his evaluation, he confirmed that the patient is progressing quite well. The whole visit took about 10 minutes of interaction with the patient, and no new diagnosis was made.
In this scenario, CPT code 99307 is the appropriate code because the MDM is straightforward, and the patient is stable with no care plan changes.
Chronic Disease Routine Follow-Up
For this scenario, suppose a patient has type 2 diabetes and hypertension, but these conditions are well controlled. The patient is currently in a skilled nursing facility.
During a subsequent visit, the physician reviews recent blood pressure readings and glucose logs documented by nursing staff. After reading them, the physician determines that the prescribed medicines are working fine and there are no new concerns. So, complex management is not required.
Now, since the visit was straightforward and all the requirements were met, the billing department can use CPT code 99307 to bill the E/M session.
Applicable Modifiers for CPT Code 99307
The following are some commonly used modifiers with CPT code 99307:
| Modifier | Name | When to Use |
|---|---|---|
| Modifier 25 | Significantly separate E/M service. | Used when the subsequent E/M visit is performed as a significant, separately identifiable service on the same day as another minor procedure. |
| GT | Interactive audio/video telecommunication | Used as an alternative telehealth modifier. |
| GQ | Telehealth services | Used when the subsequent E/M visit becomes a telehealth service delivered through an asynchronous telecommunications system. |
CPT Code 99307 – Billing & Reimbursement Guidelines
Here are some additional guidelines that will help you avoid denials for CPT code 99307:
Use the Correct Place of Service Code
This is one of the most common denial reasons for this code. 99307 must be billed with a nursing facility place of service (POS) code. Here are the two POS codes that are valid:
- POS 31: Skilled Nursing Facility
- POS 32: Nursing Facility
Provide Detailed Documentation
At a minimum, the medical record for a 99307 visit should include:
- A medically appropriate interval history relevant to the reason for the visit.
- Physical examination findings, even if limited in scope.
- Assessment and plan that reflects straightforward MDM.
- Total time on the date of the encounter if time-based coding is used.
- Provider credentials and signature.
Verify the Reimbursement Rate
The Medicare reimbursement amount for the CPT code 99307 varies for each Medicare Administrative Contractor (MAC) locality. However, the national average reimbursement amount for facility settings is $37.07, and $42.09 for non-facility settings.
You can check the exact amount for your MAC address via the PFS Lookup Tool.
Wrapping Up
In this guide, we tried our best to provide you with all the information about CPT code 99307 to ensure its accurate usage. Here are the key highlights:
- Code 99307 is used to bill a subsequent (E/M) service for a patient who is already residing in a nursing facility or skilled nursing facility.
- It requires straightforward medical decision-making or a minimum of 10 minutes of total provider time.
- Providers must use the correct place of service code (POS 31 or 32) on the claim form.
Medical billing is a complex process. It can’t be done right with learning just one code. If your practice is facing denials or bottlenecks in the billing process, working with specialists can make a significant difference. Our experts at MediBillMD offer premium nursing home billing services that are backed by a 5-star rating on Clutch.
