How To Use CPT Code 99341

CPT 99341 is a code for home or residence visits for the evaluation and management of new patients, requiring a medically appropriate history and/or examination and straightforward medical decision making. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 99341.

1. What is CPT 99341?

CPT 99341 is a code used by medical professionals to bill for home or residence visits for the evaluation and management of new patients. This code is applicable when the visit requires a medically appropriate history and/or examination and straightforward medical decision making. The code is used to ensure accurate billing and reimbursement for the services provided during the visit.

2. 99341 CPT code description

The official description of CPT code 99341 is: “Home or residence visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 15 minutes must be met or exceeded.”

3. Procedure

The 99341 procedure involves the following steps:

1. Provider arrives at the patient’s home or residence.
2. Provider performs a medically appropriate history and/or examination.
3. Provider assesses the patient’s condition and determines the level of medical decision making required.
4. Provider spends at least 15 minutes on the encounter, including face-to-face and non-face-to-face activities.
5. Provider documents the encounter and any necessary follow-up care.

4. Qualifying circumstances

Patients eligible to receive CPT code 99341 services are new patients who require a home or residence visit for evaluation and management. The visit must involve a medically appropriate history and/or examination and straightforward medical decision making. The patient’s home or residence can include a private residence, short-term accommodation, assisted living facility, group home, custodial care facility, or residential substance abuse treatment facility.

5. When to use CPT code 99341

It is appropriate to bill the 99341 CPT code when a provider sees a new patient for a home or residence visit involving evaluation and management, and the visit requires a medically appropriate history and/or examination and straightforward medical decision making. The provider must spend at least 15 minutes on the encounter, including both face-to-face and non-face-to-face activities, but not travel time.

6. Documentation requirements

To support a claim for CPT 99341, the following information must be documented:

• Patient’s demographic information, including name, date of birth, and address.
• Date and location of the encounter.
• Reason for the visit and presenting problem(s).
• Medically appropriate history and/or examination performed.
• Level of medical decision making involved.
• Total time spent on the encounter, including face-to-face and non-face-to-face activities.
• Any tests ordered, results reviewed, or consultations with other healthcare providers.
• Diagnosis, treatment plan, and any follow-up care required.

7. Billing guidelines

When billing for CPT code 99341, it is important to follow these guidelines:

• Ensure that the visit meets the criteria for a new patient home or residence visit, including a medically appropriate history and/or examination and straightforward medical decision making.
• Document the total time spent on the encounter, including face-to-face and non-face-to-face activities, but not travel time.
• Include all necessary documentation to support the claim, as outlined in the documentation requirements section.
• Verify that the patient’s insurance plan covers home or residence visits for evaluation and management services.

8. Historical information

CPT 99341 was added to the Current Procedural Terminology system on January 1, 1992. Since then, there have been several updates to the code description, with the most recent change occurring on January 1, 2023.

9. Similar codes to CPT 99341

Five similar codes to CPT 99341 and how they differentiate are:

• CPT 99342: This code is for home or residence visits for new patients with a higher level of medical decision making or longer total time spent on the encounter.
• CPT 99343: This code is for home or residence visits for new patients with an even higher level of medical decision making or longer total time spent on the encounter.
• CPT 99344: This code is for home or residence visits for new patients with a comprehensive level of medical decision making or longer total time spent on the encounter.
• CPT 99345: This code is for home or residence visits for new patients with the highest level of medical decision making or longest total time spent on the encounter.
• CPT 99347: This code is for home or residence visits for established patients with a lower level of medical decision making or shorter total time spent on the encounter.

10. Examples

Here are 10 detailed examples of CPT code 99341 procedures:

1. A provider visits a new patient at their home to evaluate and manage a minor skin rash, performing a focused history and examination and spending 15 minutes on the encounter.
2. A provider visits a new patient at an assisted living facility to evaluate and manage a urinary tract infection, performing a focused history and examination and spending 20 minutes on the encounter.
3. A provider visits a new patient at a group home to evaluate and manage a mild asthma exacerbation, performing a focused history and examination and spending 17 minutes on the encounter.
4. A provider visits a new patient at a residential substance abuse treatment facility to evaluate and manage a minor ankle sprain, performing a focused history and examination and spending 18 minutes on the encounter.
5. A provider visits a new patient at their home to evaluate and manage a mild allergic reaction, performing a focused history and examination and spending 16 minutes on the encounter.
6. A provider visits a new patient at a short-term accommodation to evaluate and manage a minor gastrointestinal issue, performing a focused history and examination and spending 19 minutes on the encounter.
7. A provider visits a new patient at a custodial care facility to evaluate and manage a mild headache, performing a focused history and examination and spending 15 minutes on the encounter.
8. A provider visits a new patient at their home to evaluate and manage a minor skin infection, performing a focused history and examination and spending 20 minutes on the encounter.
9. A provider visits a new patient at an assisted living facility to evaluate and manage a mild upper respiratory infection, performing a focused history and examination and spending 17 minutes on the encounter.
10. A provider visits a new patient at a group home to evaluate and manage a minor musculoskeletal issue, performing a focused history and examination and spending 18 minutes on the encounter.