{"id":167548,"date":"2026-07-27T13:07:05","date_gmt":"2026-07-27T13:07:05","guid":{"rendered":"https:\/\/pabau.com\/?p=167548"},"modified":"2026-08-17T11:56:32","modified_gmt":"2026-08-17T11:56:32","slug":"cpt-code-99307","status":"publish","type":"post","link":"https:\/\/pabau.com\/nl\/procedure-codes\/cpt-code-99307\/","title":{"rendered":"CPT Code 99307: Subsequent nursing facility care billing guide"},"content":{"rendered":"\n<script type=\"application\/ld+json\">{\"@context\":\"https:\/\/schema.org\",\"@type\":\"MedicalWebPage\",\"headline\":\"CPT Code 99307: Subsequent nursing facility care billing guide\",\"description\":\"CPT Code 99307 covers subsequent nursing facility care with straightforward MDM. Includes 2026 Medicare rates, RVUs, documentation requirements, and billing guidelines.\",\"url\":\"https:\/\/pabau.com\/procedure-codes\/cpt-code-99307\/\",\"audience\":{\"@type\":\"MedicalAudience\",\"audienceType\":\"Clinician\"},\"reviewedBy\":{\"@type\":\"Person\",\"name\":\"Dr Vanja Kitanova\",\"jobTitle\":\"Medical Reviewer\",\"affiliation\":{\"@type\":\"Organization\",\"name\":\"Pabau\"},\"knowsAbout\":[\"Medical Coding\",\"Clinical Documentation\",\"Healthcare Billing\",\"Clinical Safety\"],\"sameAs\":\"https:\/\/pabau.com\/blog\/author\/vanja\/\"},\"datePublished\":\"2026-07-25\",\"dateModified\":\"2026-07-27\"}<\/script>\n\n\n        <div id=\"key_takeaways\">\n            <div class=\"header\">\n                                    <img decoding=\"async\" src=\"https:\/\/pabau.com\/wp-content\/uploads\/2025\/12\/Key-Takeaways-Icon.svg\" alt=\"Key Takeaways\" height=\"42\" width=\"42\">\n                                <h3>Key Takeaways<\/h3>\n            <\/div>\n            <div class=\"list\">\n                                                            <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>CPT Code 99307 describes a subsequent nursing facility visit requiring a medically appropriate history and\/or exam with straightforward medical decision making (MDM).<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>Straightforward MDM means minimal problems addressed, minimal data reviewed, and minimal risk of complications. Selecting 99308 without meeting the low-complexity MDM threshold creates upcoding exposure.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>The 2026 Medicare blended national average payment for CPT Code 99307 is approximately $42, but POS 31 (skilled nursing facility) and POS 32 (nursing facility) no longer pay identically under CY2026 rules. Confirm the exact per-POS figure via the CMS Physician Fee Schedule Look-Up Tool.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>Pabau&#8217;s claims management software and digital forms help NF care providers document MDM complexity correctly, flag coding mismatches before submission, and track RVU productivity across nursing facility visits.<\/p>\n                        <\/div>\n                                                <\/div>\n        <\/div>\n    \n\n\n<p class=\"wp-block-paragraph\"><strong>CPT Code 99307<\/strong> is a subsequent nursing facility care E\/M code, billed when a physician or other qualified healthcare professional performs a medically appropriate history and\/or exam with straightforward medical decision making (MDM). It is the lowest-complexity tier in the 99307-99310 code family.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Bill one level up without documentation to support it and the claim carries upcoding risk. Bill 99307 when the note documents higher complexity, and the practice leaves reimbursement on the table.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">This guide covers the official descriptor, MDM thresholds, documentation checklist, 2026 Medicare reimbursement rates, RVUs, ICD-10 crosswalk, and billing guidelines for CPT Code 99307, including how it fits within the 99307-99310 range and the full 99304-99318 nursing facility care family.<\/p>\n\n\n\n<figure class=\"wp-block-embed is-type-video is-provider-youtube wp-block-embed-youtube wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe title=\"CPT Coding Pitfalls Every Medical Practice Faces\" width=\"800\" height=\"450\" src=\"https:\/\/www.youtube.com\/embed\/vbvV5okdXKg?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n<\/div><\/figure>\n\n\n\n<h2 id=\"h-cpt-code-99307-official-description-and-key-details\" class=\"wp-block-heading\">CPT Code 99307: Official description and key details<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">According to the <a href=\"https:\/\/www.ama-assn.org\/practice-management\/cpt\/cpt-code-set-overview\" target=\"_blank\" rel=\"nofollow noopener\">American Medical Association (AMA)<\/a>, which owns and publishes the CPT code set, CPT Code 99307 describes a subsequent nursing facility care service in which the physician or other qualified healthcare professional (QHP) performs a medically appropriate history and\/or physical examination with straightforward medical decision making.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">It is an Evaluation and Management (E\/M) code used exclusively for patients who are already residents of a nursing facility and who have been seen there at least once before. It does not apply to the initial admission assessment (99304-99306) or the annual reassessment (99318).<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The 2023 AMA E\/M guideline revisions, which extended the 2021 office-visit changes to nursing facility codes, eliminated the requirement to document a specific history and examination level. The medically appropriate history and exam is now at the clinician&#8217;s discretion, and <strong>MDM complexity alone<\/strong> determines which subsequent NF care code applies.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Field<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Detail<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Code<\/td>\n<td style=\"padding:12px 16px;color:#374151\">99307<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Official descriptor<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Subsequent nursing facility care, per day; medically appropriate history and\/or exam, straightforward MDM<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Code type<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Evaluation and Management (E\/M)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Place of service<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Nursing facility (POS 32) or skilled nursing facility (POS 31) \u2014 these no longer pay identically under CY2026 rules; see the reimbursement section below<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Visit type<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Subsequent (not initial admission; not annual assessment)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Eligible providers<\/td>\n<td style=\"padding:12px 16px;color:#374151\">MD, DO, NP, PA, CNS (independently or incident-to; state rules apply)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Billing frequency<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Once per day per provider<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<h2 id=\"h-medical-decision-making-requirements-for-cpt-code-99307\" class=\"wp-block-heading\">Medical decision making requirements for CPT Code 99307<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Straightforward MDM, as defined by the AMA 2023 E\/M guidelines, requires that the clinician address a minimal number of problems, review minimal data, and face minimal risk of complications or morbidity. In practice, a typical straightforward NF visit involves one stable chronic condition being monitored without any active management change.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The table below compares all four subsequent nursing facility care codes by MDM level, which is the sole distinguishing criterion since 2023.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Code<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">MDM Level<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Typical Clinical Scenario<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">2026 Medicare Rate (Blended, Approx.)*<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">99307<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Straightforward<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Stable hypertension or GERD check; no medication change; no acute issue<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Approx. $42<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">99308<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Low complexity<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Two or more stable chronic conditions; minor medication adjustment<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Approx. $65<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">99309<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Moderate complexity<\/td>\n<td style=\"padding:12px 16px;color:#374151\">New acute illness requiring prescription drug management; exacerbation of a chronic condition<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Approx. $101<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">99310<\/td>\n<td style=\"padding:12px 16px;color:#374151\">High complexity<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Acute or chronic illness posing threat to life; complex management decisions<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Approx. $152<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">*These figures are blended national averages and should be treated as rough approximations only. Under the CY2026 Medicare Physician Fee Schedule final rule, the practice-expense RVU methodology changed so POS 31 (skilled nursing facility) and POS 32 (nursing facility) no longer receive identical payment.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">POS 31 is reimbursed at the lower facility-adjusted practice-expense rate, while POS 32 is reimbursed at the higher non-facility-adjusted rate, so the two place-of-service codes are no longer interchangeable for payment purposes.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Pull the exact per-code, per-POS payment amount from the CY2026 PFS final rule Addendum B or the <a href=\"https:\/\/www.cms.gov\/medicare\/physician-fee-schedule\/search\/overview\" target=\"_blank\" rel=\"nofollow noopener\">CMS Physician Fee Schedule<\/a> Look-Up Tool before billing, rather than relying on the blended figures above.<\/p>\n\n\n\n<h2 id=\"h-documentation-requirements-for-cpt-code-99307\" class=\"wp-block-heading\">Documentation requirements for CPT Code 99307<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Inadequate documentation is the leading cause of 99307 audits and downcodes. The medical record must support the MDM level selected. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The following elements are required for a defensible 99307 claim:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Date of service<\/strong> and place of service (POS 32 or 31)<\/li>\n\n\n\n<li><strong>Provider identity and credentials<\/strong> (name, NPI, specialty)<\/li>\n\n\n\n<li><strong>Chief complaint or reason for visit<\/strong> (medically appropriate history)<\/li>\n\n\n\n<li><strong>Relevant physical examination findings<\/strong> (at the clinician&#8217;s clinical discretion)<\/li>\n\n\n\n<li><strong>MDM documentation<\/strong> specifically supporting the &#8220;straightforward&#8221; level: problem(s) addressed, data reviewed, and risk of complications<\/li>\n\n\n\n<li><strong>Assessment and plan<\/strong> that is consistent with the MDM recorded<\/li>\n\n\n\n<li><strong>Provider signature<\/strong> (electronic or wet ink)<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">A note that documents two chronic conditions with an active medication change will not support 99307. That scenario meets low-complexity MDM and belongs under 99308. Matching the note content to the code is not optional. Payers cross-reference MDM documentation against the billed code during claims review. Using digital forms with structured MDM fields reduces the risk of underdocumented or mismatched claims.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/cdn.pabau.com\/cdn\/attachments\/pulse\/content-engine\/billing_codes\/cpt-code-99307\/digital-forms.webp\" alt=\"Digital forms\"\/><figcaption class=\"wp-element-caption\"><em>Digital forms<\/em><\/figcaption><\/figure>\n\n\n\n<div style=\"height:20px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n        <div id=\"pro_tip\">\n            <div class=\"img\">\n                <svg width=\"42\" height=\"42\" viewBox=\"0 0 42 42\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M12.6383 19.5238C12.6632 21.2071 12.8734 22.9926 12.0685 24.5523C11.0341 26.8917 8.45076 28.169 7.56292 30.5918C6.63082 33.1061 7.19505 36.185 9.31371 37.9786C10.929 39.5678 13.4183 39.9873 15.6061 39.5463C17.4592 39.073 19.1049 37.8388 19.9706 36.1608C20.781 34.7141 20.7866 32.9904 20.5293 31.3985C20.1006 29.3092 18.3775 27.8705 16.9807 26.362C14.8814 24.1005 14.6684 20.6854 15.595 17.8915C16.4331 15.4768 19.0026 14.2344 20.0425 11.9461C20.7202 10.6769 20.7506 9.20327 20.6068 7.81304C20.1864 5.40098 18.3139 3.23631 15.8716 2.56674C13.9742 2.03969 11.8224 2.30052 10.1739 3.37614C8.70522 4.34688 7.5878 5.86618 7.28356 7.58178C6.76081 9.82981 7.53525 12.2822 9.20307 13.9118C10.7658 15.4741 12.4806 17.2273 12.6383 19.5238Z\"\n                        fill=\"#2BADD4\" \/>\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M22.7048 19.8387C22.6822 22.3279 24.4507 24.6234 26.7493 25.4682C28.0531 25.961 29.4725 25.9183 30.7989 25.5487C32.0575 24.9955 33.301 24.2237 34.0069 23.0092C34.8384 21.5811 35.2982 19.8286 34.7832 18.2094C34.3611 16.2507 32.8739 14.6541 31.0275 13.9426C28.6736 12.9595 25.8073 13.7942 24.1719 15.7001C23.2022 16.8366 22.6143 18.3326 22.7048 19.8387Z\"\n                        fill=\"#2BADD4\" \/>\n                <\/svg>\n            <\/div>\n            <div class=\"text\">\n                <h3>Pro Tip<\/h3>\n                <p>Before billing 99307, ask: does the note document exactly one minimal-risk problem with no data complexity and no prescription risk? If the answer includes words like &#8216;adjusted,&#8217; &#8216;new medication,&#8217; or &#8216;acute exacerbation,&#8217; the visit likely qualifies for 99308 or higher. Document what happened, then select the code the note supports.<\/p>\n            <\/div>\n        <\/div>\n    \n\n\n<p class=\"wp-block-paragraph\">With <a href=\"https:\/\/pabau.com\/features\/telehealth-software\/\">built-in video consultations<\/a>, follow-up E\/M visits happen without the patient leaving home.<\/p>\n\n\n\n<h2 id=\"h-cpt-code-99307-vs-99308-vs-99309-vs-99310-key-differences\" class=\"wp-block-heading\">CPT Code 99307 vs 99308 vs 99309 vs 99310: Key differences<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The 99307-99310 range covers all subsequent nursing facility visits. Each code maps to one MDM complexity level. There is no overlap. The most common billing error is using 99307 as a default code for routine visits rather than selecting the code the documented MDM supports.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Beyond MDM level and payment rate, the four codes share the same documentation structure, the same eligible provider types, and the same place-of-service rules. The only functional difference is the clinical complexity threshold. A clear grasp of medical decision making is what separates a defensible 99307 claim from an audit flag.<\/p>\n\n\n\n<h3 id=\"h-how-to-distinguish-99307-from-99308-in-practice\" class=\"wp-block-heading\">How to distinguish 99307 from 99308 in practice<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">The boundary between 99307 (straightforward) and 99308 (low complexity) is where most upcoding scrutiny falls. Low complexity requires at least two of the following:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Two or more stable chronic conditions<\/li>\n\n\n\n<li>An undiagnosed new problem with uncertain prognosis<\/li>\n\n\n\n<li>A prescription drug management decision<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">If only one stable chronic condition is addressed with no management change, 99307 is correct. If the clinician adjusts a medication for that condition, the visit crosses into low complexity.<\/p>\n\n\n\n<h2 id=\"h-how-cpt-99307-relates-to-initial-nursing-facility-care-codes-99304-99306\" class=\"wp-block-heading\">How CPT 99307 relates to initial nursing facility care codes (99304-99306)<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The full nursing facility E\/M code family spans 99304-99318. Understanding where 99307 sits within this range prevents billing the wrong category entirely, which is a common error when a patient transfers facilities or returns from a hospital stay.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Code Range<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Visit Type<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">When to Use<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">99304-99306<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Initial nursing facility care<\/td>\n<td style=\"padding:12px 16px;color:#374151\">First visit for admission or readmission to the facility; comprehensive assessment required<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">99307-99310<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Subsequent nursing facility care<\/td>\n<td style=\"padding:12px 16px;color:#374151\">All follow-up visits after the initial admission assessment; differentiated by MDM complexity<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">99318<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Annual nursing facility assessment<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Annual comprehensive evaluation; federally mandated; distinct from routine subsequent visits<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">A patient returning from a hospital stay and readmitted to the same nursing facility requires a new initial care code (99304-99306), not 99307. The subsequent care codes apply only once the patient is established in the facility following that admission assessment.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Good patient care management workflows prevent this category error by flagging readmission events in the scheduling system before the visit note is created. A standardized family medical history form keeps that initial comprehensive assessment consistent across admissions.<\/p>\n\n\n\n<h2 id=\"h-medicare-reimbursement-rate-for-cpt-code-99307-2026\" class=\"wp-block-heading\">Medicare reimbursement rate for CPT Code 99307 (2026)<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Medicare is the dominant payer for nursing facility services. The 2026 national blended average payment for CPT Code 99307 is approximately $42 per visit, but this blended figure no longer reflects how Medicare pays the code under CY2026 rules.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Under the CY2026 Medicare Physician Fee Schedule final rule, the practice-expense RVU methodology now pays POS 31 (skilled nursing facility) and POS 32 (nursing facility) differently. POS 31 receives the lower facility-adjusted practice-expense rate, and POS 32 receives the higher non-facility-adjusted rate.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Treat the $42 blended figure as a rough approximation only. Confirm the exact per-POS payment for your locality using the CY2026 PFS final rule Addendum B or the CMS Physician Fee Schedule Look-Up Tool.<\/p>\n\n\n\n<h3 id=\"h-relative-value-units-rvus-for-cpt-99307\" class=\"wp-block-heading\">Relative value units (RVUs) for CPT 99307<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">RVUs translate directly into payment. The formula is: Total RVU x Geographic Practice Cost Index (GPCI) x Conversion Factor. For 2026, the Medicare conversion factor is approximately $33.40 for clinicians not participating in an Advanced Alternative Payment Model (APM), and approximately $33.57 for qualifying APM participants.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Use the <a href=\"https:\/\/fastrvu.com\/tools\/rvu-lookup\" target=\"_blank\" rel=\"nofollow noopener\">FastRVU 2026 lookup tool<\/a> to pull the current work, practice expense, and malpractice RVU components for 99307 by locality.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">RVU Component<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Value (approx.)<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">What It Represents<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Work RVU (wRVU)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">0.76<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Physician time and clinical judgment<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Practice Expense RVU (PE)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">0.35<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Overhead costs (approx.; now varies by POS 31 vs POS 32 under CY2026 rules)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Malpractice RVU (MP)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">0.05<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Professional liability cost<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Total RVU<\/td>\n<td style=\"padding:12px 16px;color:#374151\">1.16<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Approx., blended figure (sum before GPCI adjustment and conversion factor); varies by POS under CY2026 rules<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">These RVU values are approximate and blended for illustration only. Under CY2026 rules, the practice-expense RVU (and therefore the total RVU) now varies by place of service, since POS 31 uses the lower facility-adjusted practice-expense rate and POS 32 uses the higher non-facility-adjusted rate.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Verify the exact, POS-specific RVU components against the CMS Physician Fee Schedule Addendum B or the Physician Fee Schedule Look-Up Tool for your specific locality and provider type.<\/p>\n\n\n\n<h2 id=\"h-federally-mandated-nursing-facility-visit-requirements-for-cpt-code-99307\" class=\"wp-block-heading\">Federally mandated nursing facility visit requirements for CPT Code 99307<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">CMS requires that physicians (or their authorized NPP designees) visit nursing facility patients on a federally mandated schedule. These mandated visits are billable under CPT Code 99307 through 99310 depending on the MDM documented. The mandate matters most for physicians who split time between a direct primary care panel and nursing facility rounds, where a missed mandated visit is both a compliance problem and a lost billing opportunity.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Under CMS Medicare Claims Processing Manual (Pub 100-04) Transmittal R808CP, the mandatory visit schedule for nursing facility patients is:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>First 90 days of a nursing facility stay:<\/strong> At least one physician visit every 30 days<\/li>\n\n\n\n<li><strong>After the first 90 days:<\/strong> At least one physician visit every 60 days<\/li>\n\n\n\n<li><strong>Alternating visits permitted:<\/strong> After the first required visit, non-physician practitioners (NPs, PAs) may alternate with the physician on subsequent mandated visits<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Each mandated visit must generate a compliant note. 99307 is appropriate when the mandated check-in involves stable, low-acuity monitoring with no management changes. Practices using HIPAA-compliant documentation practices in their NF workflows can schedule and document these mandatory visits consistently and avoid missed encounters. The HIPAA compliance checklist outlines the documentation standards that apply to these mandated encounters.<\/p>\n\n\n\n<h2 id=\"h-icd-10-cm-codes-commonly-billed-with-cpt-code-99307\" class=\"wp-block-heading\">ICD-10-CM codes commonly billed with CPT Code 99307<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">CPT Code 99307 requires a supporting ICD-10-CM diagnosis code on every claim. The diagnosis code must reflect the condition addressed during the visit, not a general &#8220;nursing facility&#8221; status. Payers cross-reference the diagnosis against the MDM level and the clinical scenario documented in the note. Using <a href=\"https:\/\/www.aapc.com\/codes\/cpt-codes-range\/\" target=\"_blank\" rel=\"nofollow noopener\">AAPC&#8217;s CPT code reference<\/a> alongside CMS ICD-10 guidance helps coders confirm current FY2026 code validity before submission.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">ICD-10-CM Code<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Description<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Common NF Context<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">I10<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Essential (primary) hypertension<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Stable BP monitoring; no medication adjustment<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">F03.90<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Unspecified dementia without behavioral disturbance<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Routine cognitive status check; no acute behavioral change<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">J44.1<\/td>\n<td style=\"padding:12px 16px;color:#374151\">COPD with acute exacerbation<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Note: exacerbation typically elevates MDM to moderate (99309)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">N39.0<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Urinary tract infection, site not specified<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Stable, resolving UTI on established antibiotic course; no change needed<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">I50.9<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Heart failure, unspecified<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Stable CHF; volume status acceptable; no medication change<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">E11.9<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Type 2 diabetes mellitus without complications<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Stable glucose monitoring visit; no regimen adjustment<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">Note the J44.1 example above: a COPD exacerbation typically raises MDM to moderate complexity, which belongs under 99309. Pairing J44.1 with 99307 on the same claim creates a clinical inconsistency that triggers payer review.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">By contrast, the stable E11.9 diabetes scenario above supports 99307 only while glucose control stays on the established regimen. Sharing a structured diabetes diet plan with the care team helps keep that &#8220;no regimen adjustment&#8221; finding accurate.<\/p>\n\n\n\n<h2 id=\"h-billing-guidelines-and-common-errors-for-cpt-code-99307\" class=\"wp-block-heading\">Billing guidelines and common errors for CPT Code 99307<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">CMS and commercial payers apply specific rules when processing 99307 claims. Violating any of these creates denials, audits, or repayment demands. Practices implementing a paperless HIPAA-compliant practice workflow catch these issues at the point of documentation rather than during post-submission audit.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>One code per day per provider:<\/strong> Only one subsequent NF care code (99307-99310) may be billed per day by the same provider for the same patient, regardless of visit duration.<\/li>\n\n\n\n<li><strong>Do not upcode to 99308 as a default:<\/strong> 99307 is not a &#8220;starter&#8221; code to avoid. It is the clinically correct code when MDM is genuinely straightforward. Routinely billing 99308 for all NF visits is an OIG audit flag.<\/li>\n\n\n\n<li><strong>Modifier -25 for same-day procedures:<\/strong> If a separate E\/M service is medically necessary on the same day as a procedure, append modifier -25 to 99307 to indicate a significant, separately identifiable service.<\/li>\n\n\n\n<li><strong>Telehealth with modifier -95 or -GT:<\/strong> Some payers allow 99307 via telehealth for established nursing facility patients. Append modifier -95 (synchronous telemedicine) or -GT per payer-specific policy.<\/li>\n\n\n\n<li><strong>Split\/shared visit rules:<\/strong> When a physician and an NP or PA both contribute to the same NF visit, the supervising physician must review and contribute to the final note, and the claim should reflect the provider who performed the substantive portion of the visit.<\/li>\n\n\n\n<li><strong>Incident-to billing does not apply in NF settings:<\/strong> Incident-to rules that apply in office settings do not extend to nursing facility care. NPPs must bill under their own NPI in this setting, which also means they receive 85% of the physician fee schedule rate under Medicare \u2014 there is no incident-to exception in this setting.<\/li>\n<\/ul>\n\n\n\n<h3 id=\"h-modifier-reference-for-cpt-99307\" class=\"wp-block-heading\">Modifier reference for CPT 99307<\/h3>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Modifier<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Purpose<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">When to Apply<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">-25<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Significant, separately identifiable E\/M on procedure day<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Same-day minor procedure also performed; E\/M must be separately documented<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">-52<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Reduced services<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Service substantially less than typically required; some payers require with NF modifier rules<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">-95<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Synchronous telemedicine<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Real-time audio-visual NF visit; payer-specific eligibility required<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">-GT<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Via interactive audio and video<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Legacy telehealth modifier; still required by some commercial payers<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<h2 id=\"h-who-can-bill-cpt-code-99307\" class=\"wp-block-heading\">Who can bill CPT Code 99307?<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">CPT Code 99307 may be billed by any qualified healthcare professional with recognized scope of practice for nursing facility E\/M services. Many of these clinicians also run a GP clinic panel alongside their NF rounds, so their billing workflow needs to handle both settings. Eligible provider types under CMS include:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Medical Doctors (MD) and Doctors of Osteopathy (DO)<\/strong><\/li>\n\n\n\n<li><strong>Nurse Practitioners (NP)<\/strong> billing under their own NPI (85% of physician rate under Medicare)<\/li>\n\n\n\n<li><strong>Physician Assistants (PA)<\/strong> billing under their own NPI (85% rate)<\/li>\n\n\n\n<li><strong>Clinical Nurse Specialists (CNS)<\/strong> with appropriate state scope authorization<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">NPs and PAs can bill 99307 independently in nursing facility settings, but incident-to rules do not apply here. Each NPP bills under their own NPI.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">State-specific scope-of-practice rules determine whether an NP or PA can practice independently in a nursing facility without a supervising physician agreement. These rules vary by state and should be verified against current state law before establishing a billing model.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Knowing the practice management vs EMR difference helps practices structure their billing workflows correctly by provider type from the outset. The nurse practitioner private practice guide covers NP billing authority rules in more detail for practices building out their NF care teams.<\/p>\n\n\n        <div id=\"book_a_demo\">\n            <div class=\"left-side\">\n                <div class=\"logo\">\n                    <img decoding=\"async\"\n                        src=\"https:\/\/pabau.com\/wp-content\/uploads\/2026\/01\/Logo.svg\"\n                        alt=\"Logo\"\n                        loading=\"lazy\"\n                    \/>\n                <\/div>\n\n                <h3 class=\"heading\">\n                    Automate your nursing facility billing workflow                <\/h3>\n\n                <p class=\"description\">\n                    Pabau helps NF care providers document MDM complexity correctly, match ICD-10 codes to visit notes, and track RVU productivity across all providers &#8211; so your 99307-99310 claims go out clean the first time.                <\/p>\n\n                <div class=\"button-group\">\n                    <a href=\"\/book-demo\/\" class=\"btn btn-scale-effect btn-cta-color btn-md\">\n                        <span class=\"btn-text\">Book a demo<\/span>\n                        <div class=\"btn-icon btn-icon-right\" aria-hidden=\"true\">\n                            <svg\n                                width=\"14\"\n                                height=\"12\"\n                                viewBox=\"0 0 14 12\"\n                                fill=\"none\"\n                                xmlns=\"http:\/\/www.w3.org\/2000\/svg\"\n                            >\n                                <path\n                                    d=\"M0.75 4.77295C0.335786 4.77295 0 5.10874 0 5.52295C0 5.93716 0.335786 6.27295 0.75 6.27295V5.52295V4.77295ZM13.2803 6.05328C13.5732 5.76039 13.5732 5.28551 13.2803 4.99262L8.50736 0.219648C8.21447 -0.073245 7.73959 -0.073245 7.4467 0.219648C7.15381 0.512542 7.15381 0.987415 7.4467 1.28031L11.6893 5.52295L7.4467 9.76559C7.15381 10.0585 7.15381 10.5334 7.4467 10.8263C7.73959 11.1191 8.21447 11.1191 8.50736 10.8263L13.2803 6.05328ZM0.75 5.52295V6.27295L12.75 6.27295V5.52295V4.77295L0.75 4.77295V5.52295Z\"\n                                    fill=\"currentColor\"\n                                ><\/path>\n                            <\/svg>\n                        <\/div>\n                    <\/a>\n                <\/div>\n            <\/div>\n\n            <div class=\"right-side\">\n                <img decoding=\"async\"\n                    src=\"https:\/\/pabau.com\/wp-content\/uploads\/2026\/01\/Home-Page-Concept-4.webp\"\n                    alt=\"Pabau practice management dashboard for nursing facility billing\"\n                    loading=\"lazy\"\n                \/>\n            <\/div>\n        <\/div>\n        \n\n\n<h2 id=\"h-how-practice-management-software-supports-accurate-99307-billing\" class=\"wp-block-heading\">How practice management software supports accurate 99307 billing<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Billing CPT Code 99307 accurately at scale, across dozens of NF patients seen weekly, requires more than coding knowledge. It requires systems that flag MDM mismatches before submission, enforce documentation completeness, and surface productivity data by provider.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Pabau&#8217;s claims management software gives NF care practices structured claim workflows that keep what is documented aligned with what is billed. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Combined with automated billing workflows, the system can route flagged claims for review before submission rather than after a denial arrives.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/cdn.pabau.com\/cdn\/attachments\/pulse\/content-engine\/billing_codes\/cpt-code-99307\/fully-integrated-with-pabau-billing.webp\" alt=\"Fully Integrated with Pabau Billing\"\/><figcaption class=\"wp-element-caption\"><em>Fully Integrated with Pabau Billing<\/em><\/figcaption><\/figure>\n\n\n\n<div style=\"height:20px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<p class=\"wp-block-paragraph\">Practice managers overseeing multi-provider NF rosters can use practice management software reporting to track RVU productivity by provider, identify patterns of undercoding (e.g., a provider billing 99307 for every visit regardless of clinical complexity), and build the audit trail that protects the practice during payer review. Going paperless accelerates this by ensuring NF visit notes are structured, searchable, and tied to the billed code at the claim level.<\/p>\n\n\n        <div id=\"pro_tip\">\n            <div class=\"img\">\n                <svg width=\"42\" height=\"42\" viewBox=\"0 0 42 42\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M12.6383 19.5238C12.6632 21.2071 12.8734 22.9926 12.0685 24.5523C11.0341 26.8917 8.45076 28.169 7.56292 30.5918C6.63082 33.1061 7.19505 36.185 9.31371 37.9786C10.929 39.5678 13.4183 39.9873 15.6061 39.5463C17.4592 39.073 19.1049 37.8388 19.9706 36.1608C20.781 34.7141 20.7866 32.9904 20.5293 31.3985C20.1006 29.3092 18.3775 27.8705 16.9807 26.362C14.8814 24.1005 14.6684 20.6854 15.595 17.8915C16.4331 15.4768 19.0026 14.2344 20.0425 11.9461C20.7202 10.6769 20.7506 9.20327 20.6068 7.81304C20.1864 5.40098 18.3139 3.23631 15.8716 2.56674C13.9742 2.03969 11.8224 2.30052 10.1739 3.37614C8.70522 4.34688 7.5878 5.86618 7.28356 7.58178C6.76081 9.82981 7.53525 12.2822 9.20307 13.9118C10.7658 15.4741 12.4806 17.2273 12.6383 19.5238Z\"\n                        fill=\"#2BADD4\" \/>\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M22.7048 19.8387C22.6822 22.3279 24.4507 24.6234 26.7493 25.4682C28.0531 25.961 29.4725 25.9183 30.7989 25.5487C32.0575 24.9955 33.301 24.2237 34.0069 23.0092C34.8384 21.5811 35.2982 19.8286 34.7832 18.2094C34.3611 16.2507 32.8739 14.6541 31.0275 13.9426C28.6736 12.9595 25.8073 13.7942 24.1719 15.7001C23.2022 16.8366 22.6143 18.3326 22.7048 19.8387Z\"\n                        fill=\"#2BADD4\" \/>\n                <\/svg>\n            <\/div>\n            <div class=\"text\">\n                <h3>Pro Tip<\/h3>\n                <p>Run a quarterly code distribution report for all subsequent NF visits. If more than 80% of claims are billed at 99307, investigate whether providers are genuinely seeing only straightforward-complexity patients or whether there is a default-coding habit. A skewed distribution toward 99307 is one of the patterns the OIG flags in E\/M audit work plans.<\/p>\n            <\/div>\n        <\/div>\n    \n\n\n<h2 class=\"wp-block-heading\">Related CPT codes<\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li><a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-99385\/\">CPT code 99385 \u2014 Preventive Visit Billing for New Patients 18-39<\/a><\/li>\n\n\n<li><a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-99308\/\">CPT code 99308 \u2014 Subsequent Nursing Facility Care<\/a><\/li>\n\n\n<li><a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-99310\/\">CPT code 99310<\/a><\/li>\n\n\n<li><a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-99315\/\">CPT code 99315 \u2014 Nursing Facility Discharge Day Management<\/a><\/li>\n<\/ul>\n\n\n\n<h2 id=\"h-conclusion\" class=\"wp-block-heading\">Conclusion<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">CPT Code 99307 is the right code when the visit, the note, and the MDM all point to straightforward complexity. Getting it wrong in either direction, whether undercoding 99309 visits as 99307 or defaulting to 99307 for all NF checks, costs the practice money or creates audit exposure. The fix is simple in principle: document what happened, then select the code the note supports.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Pabau&#8217;s claims management platform helps nursing facility care teams connect clinical documentation to correct code selection, with structured MDM templates, claim pre-submission review, and RVU tracking built in. To see how Pabau supports NF billing workflows, explore the claims management feature or <a href=\"https:\/\/pabau.com\/book-demo\/\" data-type=\"page\" data-id=\"5756\">speak with the team<\/a>.<\/p>\n\n\n        <div id=\"expert_picks\">\n            <div class=\"header\">\n                                    <img decoding=\"async\" src=\"https:\/\/pabau.com\/wp-content\/uploads\/2025\/11\/Expert-Picks.svg\" alt=\"Continue your research\" height=\"42\" width=\"42\">\n                                <h3>Continue your research<\/h3>\n            <\/div>\n            <div class=\"content\">\n                                                            <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Billing a different procedure alongside NF care?<\/strong> <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-01920\/\" rel=\"noopener\">01920<\/a> covers a related anesthesia billing scenario coders may encounter alongside nursing facility care.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Tracking medication changes across NF visits?<\/strong> <a href=\"https:\/\/pabau.com\/templates\/drug-card\/\" rel=\"noopener\">A drug card template<\/a> keeps prescription details organized to support MDM documentation.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Assessing cognitive status during a subsequent NF visit?<\/strong> <a href=\"https:\/\/pabau.com\/blog\/mental-state-examination\/\" rel=\"noopener\">Mental state examination guide<\/a> covers the standard assessment tools clinicians use.<\/p>\n                        <\/div>\n                                                <\/div>\n        <\/div>\n    \n\n\n<h2 id=\"h-frequently-asked-questions\" class=\"wp-block-heading\">Frequently Asked Questions<\/h2>\n\n\n\n<div class=\"schema-faq wp-block-yoast-faq-block\"><div class=\"schema-faq-section\" id=\"faq-question-1785151493234\"><h3 class=\"schema-faq-question\">What is CPT Code 99307 used for?<\/h3> <p class=\"schema-faq-answer\">CPT Code 99307 is used to bill a subsequent nursing facility care visit in which the physician or qualified healthcare professional performs a medically appropriate history and\/or physical examination with straightforward medical decision making. It applies to follow-up visits for established nursing facility residents, not initial admissions or annual assessments.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1785151493235\"><h3 class=\"schema-faq-question\">What level of medical decision making is required for CPT 99307?<\/h3> <p class=\"schema-faq-answer\">Straightforward medical decision making is required. This means the visit addresses a minimal number of problems, involves minimal data review, and carries minimal risk of complications or morbidity. A single stable chronic condition monitored without any management change is the typical qualifying scenario.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1785151493236\"><h3 class=\"schema-faq-question\">What is the Medicare reimbursement rate for CPT Code 99307 in 2026?<\/h3> <p class=\"schema-faq-answer\">The 2026 Medicare national blended average payment for CPT Code 99307 is approximately $42, but this is a rough approximation only. Under CY2026 rules, POS 31 (skilled nursing facility) and POS 32 (nursing facility) no longer pay identically \u2014 POS 31 uses the lower facility-adjusted practice-expense rate, POS 32 the higher non-facility-adjusted rate. Confirm the exact per-POS figure for your locality using the CMS Physician Fee Schedule Look-Up Tool.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1785151493237\"><h3 class=\"schema-faq-question\">What is the difference between CPT codes 99307 and 99308?<\/h3> <p class=\"schema-faq-answer\">CPT 99307 requires straightforward MDM (one stable problem, no management change), while 99308 requires low-complexity MDM (typically two or more stable chronic conditions or a minor medication adjustment). The 2026 Medicare blended national average facility rate for 99308 is approximately $65, roughly $23 more than 99307, but under CY2026 rules the exact payment for both codes now depends on whether the visit is billed under POS 31 or POS 32. Treat these as rough approximations and confirm exact figures via the CMS Physician Fee Schedule Look-Up Tool. Selecting between the codes requires honest MDM documentation, not a billing preference.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1785151493238\"><h3 class=\"schema-faq-question\">Can nurse practitioners bill CPT Code 99307?<\/h3> <p class=\"schema-faq-answer\">Yes. Nurse practitioners can bill CPT 99307 under their own NPI in nursing facility settings and receive 85% of the Medicare physician rate. Incident-to billing rules do not apply in nursing facilities. State-specific scope-of-practice laws determine whether a supervising physician agreement is required.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1785151493239\"><h3 class=\"schema-faq-question\">What are the federally mandated nursing facility visit requirements for CPT 99307?<\/h3> <p class=\"schema-faq-answer\">CMS requires physician visits at least once every 30 days during the first 90 days of a nursing facility stay, then once every 60 days thereafter. These mandated visits are billable under 99307-99310 based on the MDM documented. Non-physician practitioners may alternate with the physician on mandated visits after the first required physician encounter.<\/p> <\/div> <\/div>\n","protected":false},"excerpt":{"rendered":"<p>CPT Code 99307 is a subsequent nursing facility care E\/M code, billed when a physician or other qualified healthcare professional performs a medically appropriate history and\/or exam with straightforward medical decision making (MDM). It is the lowest-complexity tier in the 99307-99310 code family. Bill one level up without documentation to support it and the claim [&hellip;]<\/p>\n","protected":false},"author":77,"featured_media":167547,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_yoast_wpseo_linkdex":"91","_yoast_wpseo_content_score":"60","_yoast_wpseo_is_cornerstone":"","_yoast_wpseo_keywordsynonyms":"[\"\",\"\",\"\",\"\"]","_yoast_wpseo_focuskw_text_input":"","_seo_original_html":"","footnotes":""},"categories":[1433,1546],"tags":[],"class_list":["post-167548","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-billing-codes","category-cpt-codes"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v28.2 (Yoast SEO v28.2) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>CPT Code 99307: 2026 Medicare Rates, RVUs &amp; Billing Guide<\/title>\n<meta name=\"description\" content=\"CPT Code 99307 bills a subsequent nursing facility visit with straightforward MDM. 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State-specific scope-of-practice laws determine whether a supervising physician agreement is required.","inLanguage":"nl-NL"},"inLanguage":"nl-NL"},{"@type":"Question","@id":"https:\/\/pabau.com\/nl\/procedure-codes\/cpt-code-99307\/#faq-question-1785151493239","position":6,"url":"https:\/\/pabau.com\/nl\/procedure-codes\/cpt-code-99307\/#faq-question-1785151493239","name":"What are the federally mandated nursing facility visit requirements for CPT 99307?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"CMS requires physician visits at least once every 30 days during the first 90 days of a nursing facility stay, then once every 60 days thereafter. These mandated visits are billable under 99307-99310 based on the MDM documented. 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See 2026 Medicare rates, RVUs, and documentation rules.","content_score":"60","is_cornerstone":"","related_keyphrases":[{"keyword":"99307 medicare fee schedule","score":61},{"keyword":"99307 reimbursement rate 2026","score":61},{"keyword":"nursing facility billing codes","score":83}]},"_links":{"self":[{"href":"https:\/\/pabau.com\/nl\/wp-json\/wp\/v2\/posts\/167548","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pabau.com\/nl\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/pabau.com\/nl\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/pabau.com\/nl\/wp-json\/wp\/v2\/users\/77"}],"replies":[{"embeddable":true,"href":"https:\/\/pabau.com\/nl\/wp-json\/wp\/v2\/comments?post=167548"}],"version-history":[{"count":4,"href":"https:\/\/pabau.com\/nl\/wp-json\/wp\/v2\/posts\/167548\/revisions"}],"predecessor-version":[{"id":182451,"href":"https:\/\/pabau.com\/nl\/wp-json\/wp\/v2\/posts\/167548\/revisions\/182451"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/pabau.com\/nl\/wp-json\/wp\/v2\/media\/167547"}],"wp:attachment":[{"href":"https:\/\/pabau.com\/nl\/wp-json\/wp\/v2\/media?parent=167548"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/pabau.com\/nl\/wp-json\/wp\/v2\/categories?post=167548"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/pabau.com\/nl\/wp-json\/wp\/v2\/tags?post=167548"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}