How To Use CPT Code 99349

CPT 99349 is a code for home or residence visits for the evaluation and management of established patients, requiring a medically appropriate history and/or examination and moderate level of medical decision making. This article will cover the description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 99349.

1. What is CPT 99349?

CPT 99349 is a medical billing code used for home or residence visits for the evaluation and management of established patients. This code is applicable when a medically appropriate history and/or examination is performed, and the visit involves a moderate level of medical decision making. The code is used by healthcare providers to bill for their services and ensure accurate reimbursement for the care provided to the patient.

2. 99349 CPT code description

The official description of CPT code 99349 is: “Home or residence visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded.”

3. Procedure

The 99349 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 40 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 99349.

4. Qualifying circumstances

Patients eligible to receive CPT code 99349 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 moderate level of medical decision making. The provider must spend at least 40 minutes on the encounter, including both face-to-face and non-face-to-face activities. 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 99349

It is appropriate to bill the 99349 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 required is moderate.
  • The provider spends at least 40 minutes on the encounter, including face-to-face and non-face-to-face activities.

6. Documentation requirements

To support a claim for CPT 99349, 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.
  • 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.
  • Diagnosis and treatment plan, including any tests ordered, medications prescribed, or referrals made.
  • Provider’s signature and credentials.

7. Billing guidelines

When billing for CPT code 99349, healthcare providers should adhere to the following guidelines:

  • Ensure that the encounter meets the criteria for using CPT code 99349, including the appropriate level of medical decision making and time spent on the encounter.
  • Document all required information to support the claim, as outlined in the documentation requirements section.
  • Submit the claim to the appropriate payer, including Medicare, Medicaid, or private insurance, using the correct CPT code and any applicable modifiers.
  • Follow up on any denied or underpaid claims, providing additional documentation or clarification as needed.

8. Historical information

CPT 99349 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 99349

Five similar codes to CPT 99349 and how they differentiate are:

  • CPT 99341: Involves a home visit for a new patient with a problem-focused history and examination and straightforward medical decision making.
  • CPT 99342: Involves a home visit for a new patient with an expanded problem-focused history and examination and low complexity medical decision making.
  • CPT 99343: Involves a home visit for a new patient with a detailed history and examination and moderate complexity medical decision making.
  • CPT 99344: Involves a home visit for a new patient with a comprehensive history and examination and high complexity medical decision making.
  • CPT 99345: Involves a home visit for a new patient with a comprehensive history and examination and very high complexity medical decision making.

10. Examples

Here are 10 detailed examples of CPT code 99349 procedures:

  1. A provider visits an established patient with congestive heart failure at their home to assess their condition, adjust medications, and provide education on managing symptoms.
  2. A provider visits an established patient with diabetes at their residence to perform a foot examination, review blood glucose levels, and adjust insulin dosages.
  3. A provider visits an established patient with chronic obstructive pulmonary disease (COPD) at their home to evaluate their respiratory status, adjust medications, and provide education on inhaler techniques.
  4. A provider visits an established patient with dementia at their assisted living facility to assess their cognitive function, review medications, and discuss care plans with the patient’s family.
  5. A provider visits an established patient with a history of falls at their home to perform a fall risk assessment, review medications, and provide recommendations for home modifications to reduce fall risk.
  6. A provider visits an established patient with a recent stroke at their home to assess their neurological status, review medications, and coordinate care with rehabilitation services.
  7. A provider visits an established patient with a wound infection at their home to assess the wound, change dressings, and adjust antibiotic therapy.
  8. A provider visits an established patient with depression at their home to evaluate their mental health status, review medications, and provide counseling on coping strategies.
  9. A provider visits an established patient with a history of substance abuse at their residential treatment facility to assess their progress in recovery, review medications, and coordinate care with other treatment providers.
  10. A provider visits an established patient with advanced cancer at their home to assess their pain and symptom management, adjust medications, and discuss goals of care with the patient and their family.

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