CPT codes 99341 – 99350 are home service codes used to report evaluation and management services provided to a patient residing in their own private residence (POS code 12).
Home services: new patient
99341Level 1, low severity problem, 20 minutes
99342Level 2, moderate severity problem, 30 minutes
99343Level 3, moderate to high severity problem, 45 minutes
99344Level 4, high severity problem, 60 minutes
99345Level 5, patient is unstable or significant new problem requiring immediate attention, 75 minutes
Home services: established patient
99347Level 1, self-limited or minor problem, 15 minutes
99348Level 2, low to moderate severity problem, 25 minutes
99349Level 3, moderate to high severity problem, 40 minutes
99350Level 5, patient is unstable or significant, new, high-severity problem requiring immediate attention, 60 minutes
CPT codes 99324 – 99337 are domiciliary, rest home, or custodial care services codes and are used to report evaluation and management services provided to patients living in a facility that provides room, board, and other personal assistance services, generally on a long-term basis (POS codes 13, 14, 33, and 55).
Domiciliary (assisted living, group home), rest home, or custodial care visits: new patient
99324Level 1, low severity problem, 20 minutes
99325Level 2, low to moderate severity problem, 30 minutes
99326Level 3, new patient, moderate to high severity problem, 45 minutes
99327Level 4, new patient, high severity problem, 60 minutes
99328Level 5, new patient, high complexity problem, 75 minutes
Domiciliary (assisted living, group home), rest home, or custodial care visits: established patient
99334Level 1, established patient, self-limited or minor problem, 15 minutes
99335Level 2, established patient, low to moderate severity problem, 25 minutes
99336Level 3, established patient, moderate to high severity problem, 40 minutes
99337Level 4, established patient, unstable or significant new problem, 60 minutes
Care plan oversight
99339Supervision of patient requiring complex or multidisciplinary care, 15 to 29 minutes
99340Supervision of patient requiring complex or multidisciplinary care, 30 minutes or more
Advance care planning evaluation and management services
99497Advance care planning including the explanation and discussion of advance directives such as standard forms, face-to-face with the patient, family members, or surrogate, first 30 minutes, minimum 15 minutes
99498Each additional 30 minutes, list separately and in addition to the code for the primary procedure
This information applies to public and private health insurance billing for patients of all ages.
The time spent includes telephone calls to other health professionals (not patient family members or caregivers) ordering and reviewing tests. When applicable, document 30 minutes of time spent coordinating care unrelated to a face-to-face visit.
CPT codes for prolonged services should be used in conjunction with time-based companion codes:
99354, for other outpatient setting, with direct patient contact, first hour.
99355, for each additional 30 minutes.
Place of service codes
POS 12Private residence – patient home, apartment, townhome, etc.
POS 13Domiciliary care facility – A home providing mainly custodial and personal care for people who do not require medical or nursing supervision, but may require assistance with activities of daily living because of physical or mental disability (e.g., assisted living facility, adult living facility, “sheltered living environment”).
POS 14Group, rest, or boarding home – A place where people live and are cared for when they cannot take care of themselves.
POS 33Custodial care facility – Any facility that provides nonmedical assistance with the activities of daily life (e.g., bathing, eating, dressing, using the toilet) for someone who is unable to fully perform those activities without help.
POS 55Residential substance abuse facility – A facility that provides treatment for substance (alcohol and drug) abuse to live-in residents.
Checking with the billing department of a patient's hospice agency for proper documentation and coding tips can help prevent rejected claims.
Home services are billable to home health agencies in the community. A CMC-485 form must be reviewed and signed.
G0180Home health certification, $53.00
G0179Home health recertification, $44.17
G0181Home health care, $104.31
G0182Hospice supervision, $105.67
Effective January 1, 2019, the Centers for Medicare and Medicaid Services announced in the 2019 Physician Fee Schedule Final Rule that documenting the medical necessity of a home visit instead of an office visit is no longer needed for billing purposes.