How To Use CPT Code 99348

CPT 99348 is a code for home or residence visits for the evaluation and management of an established patient, requiring a medically appropriate history and/or examination and low level of 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 99348.

1. What is CPT 99348?

CPT 99348 is a medical billing code used for home or residence visits for the evaluation and management of an established patient. This code is applicable when a medically appropriate history and/or examination is performed, and the visit involves a low level of medical decision making. The code is used by medical coders and billers to accurately document and bill for the services provided during the visit.

2. 99348 CPT code description

The official description of CPT code 99348 is: “Home or residence visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.”

3. Procedure

The 99348 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 of the patient.
3. Provider assesses the patient’s condition and determines the level of medical decision making required.
4. Provider spends at least 30 minutes on the encounter, including face-to-face and non-face-to-face activities.
5. Provider documents the encounter, including the history, examination, and medical decision making.
6. Provider bills for the service using CPT code 99348.

4. Qualifying circumstances

Patients eligible to receive CPT code 99348 services are established patients who require a home or residence visit for evaluation and management. The visit must involve a medically appropriate history and/or examination and a low level of 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 99348

It is appropriate to bill the 99348 CPT code when the following criteria are met:

• The patient is an established patient requiring a home or residence visit for evaluation and management.
• The visit involves a medically appropriate history and/or examination.
• The level of medical decision making is low.
• The provider spends at least 30 minutes on the encounter, including face-to-face and non-face-to-face activities.

6. Documentation requirements

To support a claim for CPT 99348, the following information must be documented:

• Patient’s demographic information, including name, date of birth, and insurance information.
• Date and location of the encounter.
• Medically appropriate history and/or examination performed during the visit.
• Low level of medical decision making involved in the encounter.
• Total time spent on the encounter, including face-to-face and non-face-to-face activities.
• Any additional services provided, such as counseling, education, or coordination of care.

7. Billing guidelines

When billing for CPT code 99348, follow these guidelines:

• Ensure that the patient is an established patient requiring a home or residence visit for evaluation and management.
• Verify that the visit involves a medically appropriate history and/or examination and a low level of medical decision making.
• Confirm that the provider spent at least 30 minutes on the encounter, including face-to-face and non-face-to-face activities.
• Document all services provided during the encounter, including any additional services such as counseling, education, or coordination of care.
• Submit the claim with the appropriate CPT code (99348) and any applicable modifiers.

8. Historical information

CPT 99348 was added to the Current Procedural Terminology system on January 1, 1998. There have been several updates to the code since its addition, with the most recent change occurring on January 1, 2023.

9. Similar codes to CPT 99348

Five similar codes to CPT 99348 and how they differentiate are:

• CPT 99347: This code is used for home or residence visits with a lower level of medical decision making and a shorter encounter time.
• CPT 99349: This code is used for home or residence visits with a moderate level of medical decision making and a longer encounter time.
• CPT 99350: This code is used for home or residence visits with a high level of medical decision making and an even longer encounter time.
• CPT 99341: This code is used for home or residence visits for new patients with a low level of medical decision making.
• CPT 99345: This code is used for home or residence visits for new patients with a high level of medical decision making.

10. Examples

Here are 10 detailed examples of CPT code 99348 procedures:

1. A provider visits an established patient at their home to evaluate and manage their chronic obstructive pulmonary disease (COPD) symptoms, performing a medically appropriate history and examination, and spending 35 minutes on the encounter.
2. A provider visits an established patient at their assisted living facility to evaluate and manage their diabetes, performing a medically appropriate history and examination, and spending 30 minutes on the encounter.
3. A provider visits an established patient at their group home to evaluate and manage their hypertension, performing a medically appropriate history and examination, and spending 40 minutes on the encounter.
4. A provider visits an established patient at their residential substance abuse treatment facility to evaluate and manage their anxiety, performing a medically appropriate history and examination, and spending 45 minutes on the encounter.
5. A provider visits an established patient at their home to evaluate and manage their arthritis, performing a medically appropriate history and examination, and spending 50 minutes on the encounter.
6. A provider visits an established patient at their home to evaluate and manage their asthma, performing a medically appropriate history and examination, and spending 55 minutes on the encounter.
7. A provider visits an established patient at their home to evaluate and manage their depression, performing a medically appropriate history and examination, and spending 60 minutes on the encounter.
8. A provider visits an established patient at their home to evaluate and manage their heart failure, performing a medically appropriate history and examination, and spending 65 minutes on the encounter.
9. A provider visits an established patient at their home to evaluate and manage their osteoporosis, performing a medically appropriate history and examination, and spending 70 minutes on the encounter.
10. A provider visits an established patient at their home to evaluate and manage their Parkinson’s disease, performing a medically appropriate history and examination, and spending 75 minutes on the encounter.