CPT Code 99344: Home Visit for New Patient, Moderate Complexity

Key Takeaways

CPT Code 99344 covers home or residence E/M visits for new patients requiring moderate medical decision-making or at least 60 minutes of total time on the date of the encounter.

Code 99343 was permanently deleted effective January 1, 2023, making 99344 the moderate-complexity new patient home visit code under the restructured home and residence services range.

Home visit codes 99341-99350 are only billable when services are rendered in the patient’s private residence using Place of Service code 12; billing during a hospital inpatient stay is a flagged RAC audit topic.

CPT 99344 cannot be reported on the same date as CPT 99483 (cognitive assessment and care plan service) per CMS Medicare Coverage Database Article A59036.

Home visit billing trips up even experienced coders. Claims for CPT Code 99344 get denied when practices mix up time thresholds, apply the wrong Place of Service code, or still code to the deleted 99343 two-plus years after it was removed from the CPT schedule. According to the CMS Recovery Audit Program, inappropriate billing of home visit E/M codes during inpatient stays remains an active audit topic, meaning documentation gaps carry real financial exposure. This reference covers the official description, MDM and time requirements, place of service rules, 2023 code restructuring, related codes, and the most common compliance pitfalls for 99344.

The article is written for physicians, nurse practitioners, and billing teams who conduct house calls or home-based E/M visits and need a precise, current reference on how this code works across documentation, reimbursement, and payer compliance contexts.

CPT Code 99344: Official Description and Code Criteria

CPT Code 99344 is defined by the American Medical Association as a home or residence visit for the evaluation and management of a new patient requiring a medically appropriate history and/or examination and moderate level of medical decision-making. When total time on the date of the encounter is used instead of MDM to select the code, the threshold is 60 minutes. This code falls within the New Patient Home or Residence Services range, CPT 99341-99345.

Two pathways qualify a visit for 99344. Coders must apply one consistently and document whichever basis they select.

• MDM pathway: The encounter requires moderate complexity medical decision-making as defined in the AMA’s 2023 E/M guidelines. This means at least two of three MDM elements (number and complexity of problems, amount and/or complexity of data, and risk of complications) reach the moderate threshold.
• Time pathway: Total time on the date of the encounter meets or exceeds 60 minutes. Total time includes all time the physician or qualified non-physician practitioner personally spends on the encounter that day, not just face-to-face time.

For practices tracking encounter data in their claims management software, the distinction between MDM and time pathways must be captured in the clinical note itself, not inferred after the fact.

Documentation Requirements for CPT Code 99344

Inadequate documentation is the primary reason 99344 claims face post-payment audits. The 2023 E/M revisions removed the requirement for a comprehensive history and comprehensive physical examination as mandatory components. What matters now is that the note supports the selected level of MDM or records the total time spent.

MDM Documentation Elements

When billing under the MDM pathway, the clinical note must document sufficient detail across the three MDM elements to justify moderate complexity. Practically, this means:

• Problems: One or more chronic illnesses with exacerbation, progression, or side effects of treatment; or a new problem with an uncertain prognosis; or an undiagnosed new problem with uncertain prognosis
• Data: Review and/or order of each unique test, review of external records, independent interpretation of a test performed by another provider, or independent historian involvement
• Risk: Prescription drug management; or decisions regarding hospitalization; or diagnosis or treatment significantly limited by social determinants of health

Maintaining structured client records with discrete MDM fields reduces the manual burden of reconstructing the visit’s complexity level during a payer audit. HIPAA-compliant documentation practices also ensure that home visit notes stored outside the main office environment meet security and accessibility standards.

Time-Based Documentation Elements

When selecting 99344 based on total time, the note must state the total time spent by the billing provider on the date of the encounter. The note should also document what activities that time included: reviewing records prior to the visit, the face-to-face encounter itself, documentation time, and care coordination activities performed on the same calendar date. Vague time statements like “approximately one hour” are insufficient for many payers. State the total minutes explicitly.

Well-structured medical forms completed before or during the home visit can systematically capture time increments, especially when the visit involves coordination with family members, caregivers, or other treating providers.

Place of Service Requirements and Eligibility Rules

Home visit codes, including CPT Code 99344, carry strict eligibility restrictions that differ from standard outpatient E/M codes. Getting these wrong is a direct audit trigger.

POS 12: Private Residence Only

According to Noridian Medicare, home visit services (CPT codes 99341-99350) may only be billed when services are provided in the beneficiary’s private residence using Place of Service code 12. POS 12 designates the patient’s own home, not a facility setting.

Facilities that do NOT qualify as a private residence for 99344 billing purposes include:

• Assisted living facilities (use the new home/residence codes 99341, 99342, 99344, 99345 effective January 2023 – see section on code changes below)
• Board and care facilities
• Hospital settings (inpatient, outpatient, or emergency department)
• Skilled nursing facilities
• Rehabilitation facilities

One New Patient Code Per Provider Per Patient

Only one new patient home E/M code may be reported per provider per patient. Once the first home or residence E/M is billed, all subsequent visits by the same provider use established patient codes (99347-99350). If a provider bills 99344 for an initial encounter and then bills another new patient home code for a follow-up, that second claim will be denied.

CPT Code 99344 also cannot be reported together with domiciliary codes on the same date of service. Payers apply National Correct Coding Initiative (NCCI) edits to enforce this bundling restriction.

2023 E/M Code Changes Affecting CPT 99344

The 2023 E/M revisions made significant structural changes to home and residence visit coding. Understanding what changed prevents practices from submitting claims using outdated logic.

Deletion of CPT 99343

Effective January 1, 2023, the AMA deleted CPT code 99343 from the CPT code set. As reported by the American Academy of Family Physicians, 99344 absorbed what was formerly the moderate-level range, making it the code that maps to moderate level MDM or at least 60 minutes of total time. Practices that have not updated superbills, EHR templates, or billing system code tables since 2022 may still have 99343 generating on claims, which will result in automatic denial.

Assisted Living Facility Code Consolidation

The same 2023 revision deleted the former assisted living facility codes 99324-99328 (new patient) and 99334-99337 (established patient). These were replaced by the expanded home or residence services range. CPT codes 99341, 99342, 99344, and 99345 now cover both private residence visits and assisted living facility visits, with POS code selection distinguishing the setting for billing purposes.

For practices using an EHR for private practice that conducts home-based care programs, the code table updates from 2023 should have been applied at the start of that year. Running a report on any 99343, 99324-99328, or 99334-99337 claims submitted after December 31, 2022, is worth doing as a compliance check.

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Medicare Reimbursement for CPT Code 99344

Medicare reimbursement for 99344 is calculated using the Resource-Based Relative Value Scale (RBRVS) under the CMS Physician Fee Schedule. The payment amount varies by geographic locality using a Geographic Practice Cost Index (GPCI) adjustment. Published national unadjusted rates provide a baseline, but the actual payment a practice receives depends on its Medicare Administrative Contractor (MAC) jurisdiction and the current year’s conversion factor.

For current reimbursement values, practices should reference the CMS Physician Fee Schedule look-up tool or use a tool such as the FastRVU 2026 RVU lookup to retrieve work RVU, practice expense RVU, and malpractice RVU components for 99344 by MAC locality. Home visits carry a higher geographic adjustment in some rural areas, which affects net payment.

Private payers typically reimburse 99344 at a percentage of the Medicare fee schedule or at contracted rates. Some commercial plans require prior authorization for home visit E/M services. Confirming payer-specific requirements before the visit prevents write-offs for services rendered without authorization. Practices running direct primary care workflows that include home-based services may negotiate home visit rates separately from panel fees.

Coding Rules, Bundling Restrictions, and Compliance Pitfalls

Beyond basic documentation, 99344 carries specific coding restrictions that generate denials when not followed.

Cannot Be Reported with CPT 99483

Per CMS Medicare Coverage Database Article A59036, CPT Code 99344 cannot be reported on the same date of service as CPT 99483 (Cognitive Assessment and Care Plan Service). The service elements under 99483 overlap with home E/M services, and CMS has explicitly listed 99344 among the codes excluded from same-day reporting with 99483. Billing both on the same date will result in automatic denial of one claim.

RAC Audit Risk: Billing During Inpatient Stays

The CMS Recovery Audit Contractor program maintains an active approved topic (RAC Topic 0011) specifically targeting home visit codes billed during hospital inpatient stays. Home visit codes, including 99344, may not be used for billing services provided in any setting other than the patient’s private residence. A patient who is admitted to a hospital on the same date as a billed home visit creates an automatic audit flag. Practices should verify patient census status before finalizing home visit claims.

99344 vs. 99345: When to Step Up

CPT Code 99344 maps to moderate complexity MDM or 60 minutes total time. The next level up, CPT 99345, applies when the encounter involves high complexity MDM or at least 75 minutes of total time. High complexity MDM typically involves a patient who is unstable, has a significant new problem requiring immediate attention, or presents drug therapy requiring intensive monitoring for toxicity. Upcoding to 99345 for convenience without MDM or time documentation to support it is a compliance violation. Downcoding to 99342 when 99344 criteria are met leaves revenue on the table.

Using digital intake forms completed before the home visit, including medication lists, problem lists, and care coordination notes, gives the billing team the raw material needed to audit code selection against documented MDM elements before the claim goes out. For practices exploring related CPT code sets across different visit types, understanding how MDM thresholds apply consistently across E/M categories reduces the risk of inconsistent code selection patterns that trigger payer scrutiny.

Related Home Visit Codes: 99341-99350

CPT Code 99344 sits within a family of home and residence E/M codes. Understanding the full range prevents both undercoding and overcoding. The AAPC’s Codify CPT lookup tool provides the complete code range with official descriptors for reference.

New Patient Home or Residence Codes (99341-99345)

• 99341: Straightforward MDM or 15 minutes total time
• 99342: Low complexity MDM or 30 minutes total time
• 99343: Deleted effective January 1, 2023
• 99344: Moderate complexity MDM or 60 minutes total time
• 99345: High complexity MDM or 75 minutes total time

Established Patient Home or Residence Codes (99347-99350)

• 99347: Straightforward MDM or 20 minutes total time
• 99348: Low complexity MDM or 30 minutes total time
• 99349: Moderate complexity MDM or 40 minutes total time
• 99350: High complexity MDM or 60 minutes total time

Note that the time thresholds differ between new patient and established patient codes at the moderate level. A moderate MDM encounter for a new patient requires 60 minutes (99344), while the same MDM level for an established patient requires only 40 minutes (99349). This distinction matters when a provider sees both new and established patients during the same home visit session. For practices managing a mix of visit types, structured other E/M procedure code sets alongside home visit codes should be organized in billing systems to prevent cross-contamination of code criteria.

Conclusion

Home visit billing under CPT Code 99344 requires precision across four distinct areas: code eligibility (new patient, private residence, POS 12), MDM or time documentation that meets the moderate complexity or 60-minute threshold, awareness of bundling restrictions including the 99483 same-date exclusion, and up-to-date code tables that reflect the January 2023 deletion of 99343. Each gap creates a denial or audit exposure point.

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