CPT code 99347: Home visit billing for established patients

Key Takeaways

CPT code 99347 reports E/M services for established patients seen in their home or residence, not new patients (use 99341, 99342, 99344, and 99345 for those).

Effective January 2023, 99347 requires straightforward medical decision making (MDM) or at least 20 minutes of total time with the patient.

This code cannot be billed during a hospital inpatient stay (CMS RAC Topic 0011); it appears on the Medicare telehealth list only for substance use disorder treatment, not for routine home visits.

Pabau’s claims management software helps home-visiting practices track POS codes, visit documentation, and billing workflows in one place.

CPT code 99347 reports evaluation and management (E/M) services for an established patient seen in their home or private residence. It is the lowest-complexity code in the 99347-99350 range, requiring straightforward medical decision making or at least 20 minutes of total time with the patient.

Per the American Medical Association (AMA), which maintains the CPT code set, 99347 falls under the Home or Residence Services category alongside new patient codes 99341, 99342, 99344, and 99345, and the higher-complexity established patient codes 99348-99350.

An established patient is one who has received professional services from the physician or qualified healthcare professional (or another clinician in the same group practice with the same specialty) within the past three years.

This reference covers the 2023 E/M guideline changes that affect 99347, documentation requirements, time thresholds, Medicare reimbursement, place of service rules, and common compliance pitfalls. Practices using claims management software can build these requirements directly into their billing workflows to reduce rework.

Time and medical decision making requirements for CPT code 99347

A home visit qualifies for CPT code 99347 under either of two pathways: medical decision making or total time. Providers must satisfy one, not both.

The American Academy of Family Physicians (AAFP) confirmed these thresholds when the 2023 E/M guideline changes took effect in January 2023. The current standard is 20 minutes of total time for the 99347 threshold.

Sources pre-dating 2023 may not reference an explicit time threshold, since the legacy home visit codes did not carry the same time-based minimums introduced in the 2023 E/M revision.

What counts as total time

Total time includes all time personally spent by the billing provider on the date of service. This covers time with the patient, time reviewing records before the visit, and time spent on documentation or care coordination on the same calendar day.

• Face-to-face time with the patient or family
• Reviewing results and records before the encounter
• Ordering and reviewing tests
• Care coordination with other providers on the date of service
• Documenting the visit note

Time spent by clinical staff who are not the billing provider does not count toward the 99347 threshold. Accurate time documentation in the visit note protects against payer audits, particularly for practices in functional medicine or direct primary care models that frequently include home visits in their care model.

Straightforward MDM defined

If the provider chooses MDM rather than time, the visit must meet straightforward MDM criteria. Straightforward MDM generally involves a minimal number of diagnoses or management options (typically one self-limited or minor problem), minimal or no data review, and minimal risk of complications or morbidity.

A blood pressure check for a stable, long-term patient with well-controlled hypertension is a classic example. A visit where the provider also orders new labs, adjusts medications, or discusses a new problem would likely elevate the MDM level.

Documentation requirements for CPT code 99347

Documentation for 99347 must support either the MDM level or the total time used to select the code. The 2023 E/M changes eliminated the strict history and physical exam component requirements that previously drove code selection, giving providers more flexibility while raising the bar on what the note must demonstrate.

A compliant 99347 note should include all of the following elements:

• Date of service and setting: confirm the visit occurred at the patient’s home or private residence
• Patient status: confirm established patient relationship (seen within the prior three years)
• Presenting problem: describe the chief complaint or reason for the visit
• Clinical assessment: medically appropriate history and physical examination relevant to the presenting problem
• MDM or total time: document whichever pathway supports the code selection; for time-based billing, record the total time in minutes spent on the date of service
• Plan: document the management plan, including any follow-up, medications, or referrals

Practices that use digital intake and documentation tools can structure home visit note templates to capture these fields consistently across every encounter. Structured templates reduce the risk of a note that supports the clinical care delivered but fails a payer’s documentation audit because a field was left blank.

For practices managing HIPAA-compliant documentation workflows, the HIPAA compliance checklist for primary care covers the documentation and data-handling requirements that apply to home visit records alongside office-based encounters.

Place of service billing rules for CPT code 99347

Place of service (POS) code selection directly affects reimbursement for 99347. Using the wrong POS code is one of the most common billing errors on home visit claims.

POS 12 (Home) is the standard code for visits to a patient’s private residence. AAPC coding forums confirm that 99347-99350 are also used for assisted living facilities with POS 13, but the clinical setting must match the POS submitted on the claim.

Billing POS 11 (office) for a service that occurred in the patient’s home is a coding error, regardless of where the provider completed the note. Practices conducting assisted living visits can standardize documentation with an assisted living assessment tool.

The Medicare Physician Fee Schedule applies non-facility rates for home visit codes billed with POS 12. The CMS Physician Fee Schedule lookup tool allows providers to check current reimbursement amounts by code, locality, and POS before submitting claims.

Reimbursement rates vary by geographic locality and are updated annually, so hardcoded dollar figures in internal billing guides quickly become outdated.

Medicare reimbursement and the fee schedule for CPT code 99347

Medicare pays 99347 under the non-facility rate of the Medicare Physician Fee Schedule (MPFS). Because reimbursement is locality-adjusted, the payment a practice receives depends on its geographic payment area. Practices in high-cost localities (such as Manhattan or San Francisco) typically receive higher payments than practices in rural areas for the same code.

To find current payment rates for CPT code 99347 in your locality, use the CMS Physician Fee Schedule lookup tool and filter by code, year, and modifier status. As of 2026, providers should verify rates directly rather than relying on third-party guides, which may not reflect mid-year corrections.

For practices also managing coding across specialties, the new patient office visit billing guide and the critical care services billing guide cover other E/M-adjacent code families using similar documentation logic.

Private payer reimbursement for 99347 varies by contract. Some commercial plans use Medicare rates as a benchmark (paying a percentage above or below MPFS), while others use their own fee schedules. Practices should confirm 99347 rates with each payer during contract negotiations or annual fee schedule reviews.

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Who can bill CPT code 99347

Physicians and other qualified healthcare professionals (QHPs) can bill CPT code 99347 under their own National Provider Identifier (NPI). This includes:

• Physicians (MD, DO)
• Nurse practitioners (NPs) where state scope-of-practice allows independent practice
• Physician assistants (PAs), subject to applicable supervision requirements
• Clinical nurse specialists and certified nurse midwives, depending on state law and payer requirements

Medical assistants and non-licensed clinical staff cannot independently bill CPT code 99347. Under CMS incident-to billing rules, services provided by non-physician staff may be billed under a supervising physician’s NPI when specific conditions are met, including direct supervision and the absence of a new problem that the supervising physician did not address.

Incident-to rules do not apply in home settings the same way they do in an office, so practices should verify with their MAC before billing incident-to for home visits. For home health aide services delivered alongside these visits, HCPCS code S9122 covers the aide-service billing separately from the physician E/M code.

For practices employing nurse practitioners or other advanced practice providers in a home visit model, maintaining current licensure documentation and understanding your state’s supervision requirements reduces compliance exposure. The nurse practitioner private practice guide covers scope-of-practice and billing considerations in more detail.

Compliance for CPT code 99347: Inpatient billing and telehealth exclusions

Two compliance pitfalls catch practices off guard with CPT code 99347: billing during a hospital inpatient stay and billing under the telehealth benefit.

Inpatient billing prohibition

Per CMS RAC Approved Topic 0011, CPT codes 99341-99350 (including 99347) may not be billed for services provided to a patient admitted to a hospital inpatient setting on the same date. Home Services CPT codes apply only when the service is delivered in the patient’s private residence or applicable residence setting.

Billing 99347 while the patient is an inpatient is a claim error that Recovery Audit Contractors actively target.

A common scenario: a provider sees a patient in the morning at home, and the patient is hospitalized later the same day. In that case, the home visit may still be billable, but documentation must clearly establish that the service occurred before the inpatient admission and in the home setting.

If the timeline is ambiguous, practices should review with their compliance team before submitting the claim.

Telehealth exclusion

CPT codes 99347 and 99348 do appear on the CMS List of Medicare Telehealth Services, but only for treating a substance use disorder (SUD) or a co-occurring mental health condition.

That narrow exception comes from the SUPPORT Act, which lets a patient’s home serve as an originating site for SUD treatment, even though the home is otherwise excluded from Medicare’s telehealth originating-site rules.

Outside of SUD treatment, the home is not a permissible telehealth originating site, so 99347 cannot be billed as a routine or general telehealth visit. Practices treating substance use disorders through telehealth can use a change plan worksheet to document treatment goals alongside the visit note.

A video visit to a patient who happens to be at home is not the same as a home or residence service in the CPT sense. If the provider is not physically present in the patient’s home, and the visit is not an SUD-qualifying telehealth encounter, the service does not qualify for CPT code 99347.

Practices offering routine virtual care should use appropriate telehealth E/M codes, such as 99202-99215 with the applicable place of service modifier, rather than home visit codes.

For practices managing telehealth and in-person workflows together, telehealth software that separates encounter types at the scheduling and documentation level reduces the risk of coding the wrong visit type.

Related home visit codes: 99347, 99348, 99349, and 99350

CPT code 99347 is the entry-level code in the established patient home visit range. Selecting the correct code requires matching the MDM complexity or time spent to the appropriate level. Home-based services billed by other disciplines follow separate code families, such as HCPCS code G0155 for clinical social worker home health visits.

• 99347: Straightforward MDM or 20+ minutes total time. Appropriate for self-limited or minor presenting problems where minimal data review and minimal risk are involved.
• 99348: Low MDM or 30+ minutes total time. Appropriate when there is one or more stable chronic illnesses or a new problem with minimal workup.
• 99349: Moderate MDM or 40+ minutes total time. Appropriate when there are multiple chronic conditions or a new problem requiring additional workup and prescription drug management.
• 99350: High MDM or 60+ minutes total time. Appropriate for complex presentations with high risk of morbidity, including decisions regarding hospitalization or hospice care.

Upcoding—selecting a higher-level code than the documentation supports—is a common trigger for home visit claim denials and audits. Practices should audit a sample of home visit claims quarterly to confirm that the MDM documentation or time record supports the code billed.

Practices managing multiple code families, such as those also billing level 5 ED visit codes or chronic care management services, benefit from using medical practice scheduling software that ties encounter type to the correct code family at the scheduling stage.

Common billing errors for CPT code 99347

Home visit billing generates a predictable set of recurring errors. Catching these before submission is far easier than appealing a denial or responding to a RAC audit.

• Using 99347 for a new patient: New patient home visits use 99341, 99342, 99344, and 99345. A patient seen for the first time, or one not seen within three years, is not an established patient for coding purposes.
• Applying pre-2023 time assumptions: The current minimum is 20 minutes of total time. The 2023 E/M revisions introduced explicit time thresholds for home visit codes; notes that do not document at least 20 minutes on a 99347 claim may be flagged by payers using updated edit logic.
• Missing POS code 12: Submitting a home visit claim without the correct POS code, or using POS 11 (office), results in payment at the wrong rate or outright denial.
• Incomplete MDM documentation: Listing only the diagnosis without documenting the complexity of the problem, data reviewed, or risk involved leaves the claim without auditable MDM support.
• Billing during an inpatient stay: Per CMS RAC Topic 0011, billing 99347 while the patient is admitted triggers recovery actions. Verify patient admission status on the date of service.
• Claiming telehealth reimbursement for a routine visit: 99347 and 99348 are on the Medicare telehealth list only for substance use disorder treatment. A routine virtual visit billed as a home visit will be denied.

Practices that use structured clinical records tied to billing workflows catch many of these errors at the point of documentation rather than after the claim is submitted. Keeping clinical notes, POS coding, and claim submission in a connected system removes the manual hand-off where errors most often occur.

Conclusion

CPT code 99347 is straightforward in concept but carries meaningful compliance risk in practice. The 2023 E/M changes updated the time threshold to 20 minutes, eliminated the old history and exam counting requirements, and shifted the documentation burden to MDM or time.

Any billing guide or note template pre-dating January 2023 needs to be updated. Practices billing preventive care alongside home visits may also find the CPT code 99383 preventive medicine visit guide useful for distinguishing code families.

Inpatient billing errors and telehealth misuse are avoidable with a connected clinical and billing workflow. Pabau’s claims management tools help practices tie home visit documentation to the right codes and POS settings before claims go out the door. To see how the workflow fits a home-visiting practice, book a demo.

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