CPT code 99348: Home visit billing for established patients

CPT code 99348 is an evaluation and management (E/M) code for a home or residence visit to an established patient. The visit must involve a low level of medical decision making, or at least 30 minutes of total time on the date of the encounter. Medicare allows roughly $78.83 for it in 2026 before any locality adjustment.

Since the 2023 E/M guideline overhaul, code selection for home visits hinges on either total time or medical decision making complexity. The history and physical exam elements that governed billing before that change no longer set the level.

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Key takeaways

CPT code 99348 covers established patient home visits with a low level of MDM, or at least 30 minutes of total time.

Since 2023, MDM complexity or total time sets the code level, and history and exam elements no longer do.

The national average Medicare non-facility rate for 99348 is approximately $78.83 for 2026, before locality adjustment.

Claims need the right place of service code, which is POS 12 at home, POS 13 in assisted living, and POS 33 in a domiciliary.

Practice management software like Pabau supports home visit billing with built-in CPT code libraries and automated claim submission.

CPT code 99348: official description and code definition

CPT code 99348 describes a home or residence visit for an established patient. The visit requires a medically appropriate history or examination, plus a low level of medical decision making. When total time is used for code selection instead of MDM, 30 minutes must be met or exceeded on the date of the encounter. The American Medical Association (AMA) maintains CPT code 99348 as part of the established patient home and residence services subsection (99347-99350).

The code applies whether the visit occurs in the patient’s private home, an assisted living facility, or a group home. It does not apply to encounters in a skilled nursing facility or a hospital setting, which use separate E/M code families.

When to use CPT code 99348: clinical criteria and eligibility

Use CPT code 99348 when two conditions hold. The patient has been seen by the same provider, or one in the same group practice, within the past three years. The visit itself involves a low level of MDM. Check eligibility before the visit as well, because some commercial payers treat home visit codes differently from Medicare.

The encounter must take place in one of the following settings to qualify for a home visit code:

• The patient’s private residence
• An assisted living facility (non-Medicare-certified)
• A domiciliary or rest home
• A group home

Common clinical scenarios for 99348: a check on one stable chronic condition, an uncomplicated post-procedure follow-up, or a medication review with a minor adjustment. Each sits at low MDM because the problem is stable, the data reviewed is limited, and the treatment carries low risk.

Medical decision making requirements for home visit billing

The CPT 2023 revision of the home and residence services codes was adopted for Medicare by the Centers for Medicare and Medicaid Services (CMS). Under it, CPT code 99348 maps to a low level of MDM. History and physical exam components no longer drive code selection. The provider selects the code on either the MDM level or the total time spent on the date of the encounter.

Two of those three elements must be met or exceeded for the encounter to qualify as low MDM. In practice that usually looks like one stable chronic illness, limited data to review, and either no new prescriptions or a straightforward one. Independent interpretation of a new test points to moderate MDM instead, as does starting a complex medication regimen. Both support 99349 rather than 99348.

Documentation requirements for CPT code 99348

Documentation is what separates a paid claim from a denial or an audit flag. For CPT code 99348 billed under the 2023 guidelines, the note must support whichever selection method the provider uses: MDM complexity or total time.

Required documentation elements for 99348 billed by MDM:

• Patient status: confirm the patient is established (seen within the past three years by this provider or the same group practice)
• Service setting: note the specific location (home address, assisted living facility name, group home)
• Problem list: document the presenting problems with current status for each
• MDM documentation: record the number and complexity of problems, amount of data reviewed, and risk of complications or morbidity
• Assessment and plan: include diagnoses with ICD-10 codes and the management plan for each active problem
• Provider signature: dated, credentialed, with NPI

Required elements when billing by total time:

• Total time in minutes spent on date of service (includes pre- and post-service activities, not just face-to-face)
• Total time must meet or exceed the 30-minute threshold for 99348
• A brief note on how that time was spent

The 837 claim file also requires the correct place of service code. Use POS 12 for the patient’s home, POS 13 for assisted living, and POS 33 for a domiciliary or rest home. Submitting with the wrong POS can trigger an automatic denial regardless of how strong the clinical documentation is.

CPT code 99348 reimbursement rates and Medicare fee schedule

Medicare reimbursement for CPT code 99348 varies by geographic locality. The national average non-facility rate for 2026 is approximately $78.83, based on data from the CMS Physician Fee Schedule. Always verify the exact rate for your MAC jurisdiction using the CMS lookup tool. Rates in high-cost localities such as Manhattan or San Francisco can run 20-30% above the national average.

One detail catches practices out in 2026: CMS publishes two conversion factors. Clinicians who qualify as advanced APM participants are paid on $33.5675, and everyone else is paid on $33.4009. The figures on this page use the non-qualifying factor, so a qualifying participant should expect slightly more.

Track the allowed amount alongside the electronic remittance advice for every home visit claim. That pairing catches short payments and payer adjustments early.

RVU breakdown for 99348

The FastRVU 2026 lookup tool provides current RVU values for 99348. Approximate values are shown below. Verify them against current CMS data before relying on them for budget planning.

Those three components add up to 2.36 RVUs, and the conversion factor turns that total into the allowed amount. The chart below traces the arithmetic end to end.

Use the PCC 2026 RVU calculator to apply your geographic practice cost index (GPCI) to these base values. Practices billing from high-cost localities will see meaningfully higher allowed amounts.

ICD-10 codes and modifiers commonly paired with 99348

The ICD-10 diagnosis code on a 99348 claim must support medical necessity for the home visit. Pull it from the ICD-10-CM code set that matches the condition documented in the note. The codes below are frequently paired with this service, based on common chronic disease management scenarios. They are examples, not required pairings.

Applicable modifiers for 99348

CPT 99348 vs related home visit codes: 99347, 99349, and 99350

The established patient home visit series spans four codes. Picking the wrong complexity level, even by one step, directly affects reimbursement and audit exposure. Each code pairs one MDM level with one time threshold, and either route supports the code on its own.

New patient vs established patient home visit codes

New patient home visits use 99341, 99342, 99344, and 99345. CPT deleted 99343 in 2023, so the set is no longer a continuous range. A patient counts as new if they have not received professional services within the past three years. That covers the provider and any provider of the same specialty in the same group practice. New patient codes reimburse at a higher rate, which accounts for the additional work in a first encounter.

Who can bill CPT code 99348?

Physicians (MD, DO), nurse practitioners (NP), and physician assistants (PA) can bill CPT code 99348 under Medicare. Scope-of-practice rules vary by state, and how non-physician practitioners (NPPs) bill affects what the visit pays.

The key rules for NPP billing:

• Direct billing: NPs and PAs may bill Medicare directly for home visit E/M services at 85% of the physician fee schedule rate. That applies when they act within their scope of practice.
• Incident-to billing: NPPs may bill at 100% of the physician rate under incident-to rules. That route requires direct physician supervision, with the physician on-site though not in the same room. Home visits rarely meet that condition.
• Inpatient conflict: CMS Recovery Audit Contractors (RAC) flag home visit codes billed during the same episode as an inpatient stay. Billing 99348 for an encounter during an inpatient or SNF admission is prohibited
• State scope: Rules governing what NPs and PAs can independently manage vary by state; confirm with your MAC before billing independently for complex patients

Common billing mistakes with CPT code 99348

Most CPT code 99348 denials trace back to a handful of repeatable errors. Catching them before submission costs far less than appealing afterward. A standing denial management process turns each denial into a fix that stops the next one.

• Wrong place of service code: POS 11 (office) instead of POS 12 (home) or POS 13 (assisted living) triggers an automatic edit. The claim is then denied or downcoded.
• Upcoding without documentation: Billing 99349 or 99350 when the clinical complexity only supports 99348. MDM documentation must match the code. RAC auditors specifically target home visit upcoding.
• Missing address or facility name: MACs flag home visit claims where the visit location is not documented in both the note and the claim
• Billing during inpatient status: As noted above, home visit codes cannot be billed concurrently with an inpatient admission. Check patient status before billing.
• Established patient status error: Billing 99348 for a patient who has not been seen within the past three years. These claims should use the new patient codes 99341, 99342, 99344, or 99345 instead.
• Missing time documentation: When billing by total time, the note must record the actual minutes. A note that says “spent time with the patient” without a specific figure does not support time-based billing.

How practice management software supports accurate 99348 billing

Home visit billing introduces logistical friction that office-based E/M billing avoids. Providers work away from the main system, documentation happens in the field, and claim data often needs reconciling later. Practice management software like Pabau answers that with claims tools for visiting providers. They automate the steps between the clinical encounter and the submitted claim.

Pabau’s built-in CPT code library includes the full home visit series (99347-99350). MDM complexity prompts help providers document the right level at the point of care. Claim submissions route through the Claim.MD clearinghouse, which validates CPT and ICD-10 code combinations before they reach the payer. A mismatch between 99348 and an unsupported diagnosis code gets caught early.

For practices managing homebound populations, Pabau also automates ERA posting so remittances reconcile against claims without manual entry. That matters because short payments and payer adjustments are common in home visit billing. A backlog of unposted ERAs hides systematic underpayment patterns for months.

Automate your home visit billing workflows

Pabau’s practice management software includes built-in CPT code libraries, automated claim submission via Claim.MD, and real-time eligibility checks. Your team spends less time on billing admin and more time with patients.

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Conclusion

CPT code 99348 carries most of the routine home-based care load. It covers the stable chronic disease management visits that homebound patients need regularly. Getting the code right starts with confirming the established patient relationship. Match the MDM level or the total time to the 99348 threshold, then submit with the correct place of service code.

Home visit billing accuracy depends more on the capture workflow than on the coder. Pabau’s practice management platform covers both ends, with integrated CPT code libraries, a Claim.MD clearinghouse connection, and automated ERA reconciliation. Book a demo to walk through the home visit billing setup with our team.

Continue your research

Need a primer on how clearinghouses work for home visit claims? Medical claims clearinghouse overview explains the full submission pathway from provider to payer and what happens when a claim is rejected at each stage.

Unsure how to handle denied home visit claims? Revenue cycle management fundamentals covers the end-to-end RCM process including denial appeal workflows.

Want to decode the denial that came back on a home visit claim? Denial codes in medical billing lists the CARC and RARC codes payers use, so you can tell a POS edit from a medical necessity rejection.

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