CPT code 99343 – New patient home visit

Key takeaways

CPT Code 99343 was deleted on January 1, 2023, so a claim that carries it for a later date of service is denied as invalid.

Before deletion, 99343 covered a new patient home visit with moderate-complexity medical decision making, typically 45 minutes face-to-face.

Only 99343 was deleted. Codes 99341, 99342, 99344, 99345 and 99347-99350 stayed active with new descriptors.

A former 99343 visit bills as 99344 when moderate MDM is documented, but billed by time, 45 minutes only reaches 99342.

Pabau’s claims management software, part of the practice platform we build, holds a claim until membership numbers and authorization codes are complete.

CPT Code 99343: Official descriptor and 2023 deletion

CPT Code 99343 is a deleted code for a new patient home visit at moderate complexity, typically 45 minutes face-to-face.

The American Medical Association’s CPT code set removed it effective January 1, 2023, when it overhauled the home and domiciliary E/M codes. A comparable visit now bills as 99344 when moderate MDM drives code selection.

Only 99343 was deleted from the new patient home series. Codes 99341, 99342, 99344 and 99345, plus established patient codes 99347-99350, were revised with new descriptors and remain active. The separate domiciliary and rest home codes, 99324-99337, were deleted at the same time and folded into the home codes.

The official pre-deletion descriptor defined 99343 as a home visit for the evaluation and management of a new patient, with four parts:

• Key components: a detailed history, a detailed examination, and medical decision making of moderate complexity.
• Counseling: counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies. It was provided consistent with the problem(s) and the patient’s and/or family’s needs.
• Severity: the presenting problem(s) were usually of moderate to high severity.
• Typical time: physicians typically spent 45 minutes face-to-face with the patient and/or family.

Before 2023, time could set the level only when counseling or care coordination took up more than half of the face-to-face visit. In that case, 45 minutes supported 99343.

The new patient home visit code family: 99341-99345

Before January 2023, new patient home visits used five codes, set by MDM complexity and typical time. CPT Code 99343 sat in the middle of the range. It ranked above 99342 (low complexity, 30 minutes) and below 99344 (moderate MDM with a comprehensive history and exam, 60 minutes).

Under AMA rules, a “new patient” has had no professional services from the physician, or another same-specialty physician in the group, within three years. That definition still applies under the 2023 framework.

What replaced CPT Code 99343 after January 2023?

No single code replaced CPT Code 99343. The 2023 AMA E/M overhaul deleted it and revised the remaining home visit codes. They now use MDM- or time-based selection, the same logic as office E/M codes. New patients now bill 99341, 99342, 99344 or 99345, and established patients bill 99347-99350.

The old five tiers don’t map 1:1 onto the four new ones, so a crosswalk only points toward a code. The documentation decides it. A visit that met the old 99343 criteria (moderate MDM, about 45 minutes) lands on different codes depending on the billing basis:

The 2023 framework counts total time on the date of service, including prep and documentation, rather than face-to-face time alone. Its thresholds also sit higher than the old typical times.

A 45-minute visit billed by time reaches only 99342, because 99344 needs 60 minutes. If the note supports moderate MDM, billing on MDM earns the same visit 99344.

How to bill home visits under the 2023 E/M guidelines

Billing a home visit after 2023 takes five steps. The place of service (POS) code matters as much as the CPT code, because it tells the payer which setting the home codes cover. A POS that doesn’t fit the code is one of the most preventable home visit denials.

Step-by-step billing process

1. Confirm patient type. A new patient has had no qualifying encounter with this provider or a same-specialty group member in three years. New patients use 99341, 99342, 99344 or 99345, and established patients use 99347-99350.
2. Select the billing basis. Choose either MDM or total time, not both, and document the one you select. History and exam elements no longer set the E/M level under the 2023 guidelines.
3. Assign the correct code. Match the documented MDM tier or total time to the right 2023 code (see the table above and the Medicare reimbursement table below).
4. Set the place of service code. Use POS 12 for the patient’s home, POS 13 for an assisted living facility, and POS 33 for a custodial care facility. A skilled nursing facility resident (POS 31) is billed with nursing facility codes 99304-99310 instead.
5. Submit the claim. For Medicare, submit a CMS-1500 form or an 837P electronic file. Check the code against the date of service first, because 99343 is invalid for any visit after December 31, 2022.

Place of service codes for home visits

Documentation requirements for home visit E/M services

Home visit E/M claims have long drawn Office of Inspector General (OIG) audit attention. The OIG has repeatedly flagged home visit upcoding as a high-risk billing area, so the note has to support the level billed.

MDM documentation elements

When billing by MDM, the record must support two of the three MDM elements at the claimed level. Those elements are the problems addressed, the data reviewed, and the risk of patient management.

For moderate MDM, one chronic illness with exacerbation meets the problem element. So do two stable chronic illnesses, or an undiagnosed new problem with uncertain prognosis.

• Problems: Document each active problem addressed at the visit with enough specificity to support the MDM tier. “Hypertension, managed” does not support moderate MDM on its own.
• Data: Document what information was reviewed, ordered, or interpreted (labs, imaging, external notes). Ordering a test without interpreting it does not meet the data element threshold.
• Risk: Prescription drug management counts as moderate risk. A decision about hospitalization counts as high risk.

Total time documentation

When billing by time, the record must state the total time spent on the date of service. That includes pre-visit review, the visit itself, and post-visit documentation and coordination. The note must give the total in minutes, and a generic statement like “extensive time spent” does not satisfy the requirement.

Home visit attestation requirements

For Medicare claims, the note must confirm where the visit took place and show that the service was medically necessary. Home visit E/M codes are separate from the home health benefit, so the patient doesn’t need to be certified as homebound.

Since 2019, Medicare no longer requires the note to justify why the visit happened at home instead of the office. Practices that still add that justification spend time on a requirement that no longer exists.

Medicare reimbursement rates for home visit E/M codes

CPT Code 99343 has no active Medicare rate, because it was deleted on January 1, 2023. The CMS Physician Fee Schedule lookup tool shows no reimbursement data for it in any year after 2022. For current rates, use the active home visit codes.

The rates below are 2024 Medicare Physician Fee Schedule (MPFS) non-facility rates, which apply to POS 12 and POS 13. MPFS rates change every year with the conversion factor, so check the current year in the FastRVU 2026 RVU lookup.

*Approximate 2024 national non-facility rates. Geographic adjustment factors apply, so rates vary by Medicare Administrative Contractor (MAC) jurisdiction. Verify exact rates in the CMS Physician Fee Schedule for your locality.

Who can bill home visit E/M codes?

Physicians can bill home visit E/M codes, and so can nurse practitioners, physician assistants, and clinical nurse specialists. These non-physician practitioners (NPPs) follow rules that differ by payer and billing method.

Independent billing vs. incident-to

Under Medicare, NPPs with state licensure and a Medicare enrollment number can bill home visit codes independently at 85% of the fee schedule. Incident-to billing pays 100%, but it is generally not available for home visits. It requires direct physician supervision, which the home setting rarely allows.

• Physicians (MD/DO): Bill independently at 100% of the MPFS rate.
• Nurse practitioners: Bill independently at 85%, depending on state scope-of-practice authorization and Medicare enrollment status.
• Physician assistants: Bill independently at 85%, depending on state scope-of-practice authorization and Medicare enrollment status.
• Clinical nurse specialists: Bill independently at 85%, depending on state qualification and Medicare enrollment status.
• Registered nurses (RNs) and LPNs: Cannot bill home visit E/M codes independently under Medicare.

Commercial payer rules vary. Some managed care organizations pay NPPs at 100%, while others cap at 85% or require prior authorization for home visits. Running insurance eligibility verification before the visit confirms coverage and any authorization requirement.

Prolonged services add-on codes for home visit E/M

When a home visit billed by time runs well past the top code, a prolonged services add-on can be reported with 99345 or 99350. Medicare and commercial payers use different add-on codes, and a mismatch causes a denial.

Both add-ons apply only when time selected the code. The note must record total time in minutes and show that the add-on threshold was met. For G0318, Medicare also counts time spent in the three days before and the seven days after the visit.

For commercial payers, verify that the specific plan recognizes 99417. Some managed care contracts exclude prolonged service add-ons for home visit codes.

Common denial reasons for home visit E/M claims

Most home visit E/M denials trace back to a short list of coding and documentation errors. Knowing the pattern lets you fix the upstream error before the claim leaves the practice.

Practices with a steady volume of home visit claims benefit from structured denial management workflows. Tracking denials by code and payer shows whether the root cause is documentation, POS coding, or code selection.

Our guide to medical billing denial codes explains the CARC and RARC codes that come back on each remittance.

Payer-specific rules for home visit E/M codes

Medicare sets the baseline for home visit E/M policy, but commercial payers and Medicaid programs apply their own coverage rules. Checking payer-specific requirements before billing prevents a whole class of home visit denials.

• Medicare: Follows the 2023 AMA E/M guidelines. Most jurisdictions need no prior authorization for home visit codes, but local coverage determinations (LCDs) from individual MACs may apply. Check with your MAC before billing high-complexity codes for certain conditions.
• Medicaid: Coverage and rates vary by state. Some state Medicaid programs have not adopted the 2023 AMA E/M framework and may still recognize the old 99341-99350 descriptors. Confirm the current framework with the state Medicaid agency before billing.
• Commercial / managed care: Most large commercial payers adopted the 2023 E/M framework, but home visit coverage varies widely. Some plans require prior authorization, and others exclude home visits for certain benefit designs. Check the payer’s provider manual before scheduling home visits as a billable service.
• Medicare Advantage (MA) plans: Follow CMS guidance but may add utilization management requirements. Prior authorization for home visit E/M services is common in MA plans.

Meeting clean claim submission standards on every electronic submission makes it less likely that a payer-specific edit denies a home visit code.

How Pabau keeps home visit claims clean from note to payment

Home visit denials usually start before the claim leaves the practice. A retired code typed from memory, a missing authorization number, or a POS that doesn’t match the setting is enough. Catching those by hand means a biller rereads every claim before it goes out.

Pabau, the practice management platform we build, includes claims management software that pre-fills each claim from the patient record and treatment details. Background checks hold the claim until membership numbers and authorization codes are complete, so it never goes out without them.

For US practices, Pabau submits through its Claim.MD integration, which reaches thousands of payers. Your team can run real-time eligibility checks before the visit and post ERA remittances when payment lands.

Each claim is tracked from pending to paid on one dashboard. Billers then spend their review time on the CPT code and POS instead of chasing missing numbers.

Get home visit claims paid the first time

Pabau checks membership numbers and authorization codes before submission, runs real-time eligibility checks, and sends claims through Claim.MD. Your team sees every home visit claim’s status on one dashboard.

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Conclusion

CPT Code 99343 is gone for good, and a claim that uses it after 2022 has no route to payment except a corrected resubmission. The decision that matters now is which basis you bill a former 99343 visit on. If the note supports moderate MDM, bill 99344 on MDM. Billed by time, 45 minutes only earns 99342.

The 2023 rules reward documentation over habit. A clear MDM note, a total time recorded in minutes, and the right POS protect the level you bill.

Pabau holds each claim until membership numbers and authorization codes are complete. It also checks eligibility in real time through Claim.MD and tracks every home visit claim to payment. Book a demo to see how it fits your home visit billing workflow.

Continue your research

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