How To Use CPT Code 99350

CPT 99350 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 high level of medical decision making. This article will cover topics such as the description, procedure, qualifying circumstances, when to use the code, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 99350 procedures.

1. What is CPT 99350?

CPT 99350 is a code used by medical professionals to bill for home or residence visits for the evaluation and management of established patients. These visits require a medically appropriate history and/or examination and a high level of medical decision making. The code is used to ensure accurate billing and reimbursement for the services provided during the visit.

2. 99350 CPT code description

The official description of CPT code 99350 is: “Home or residence visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded.”

3. Procedure

The 99350 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 60 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 99350.

4. Qualifying circumstances

Patients eligible to receive CPT code 99350 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 high level of medical decision making. Additionally, the provider must spend at least 60 minutes on the encounter, including both face-to-face and non-face-to-face activities.

5. When to use CPT code 99350

It is appropriate to bill the 99350 CPT code when the following criteria are met:

• The patient is an established patient.
• The visit takes place at the patient’s home or residence.
• A medically appropriate history and/or examination is performed.
• High level of medical decision making is required.
• The provider spends at least 60 minutes on the encounter, including face-to-face and non-face-to-face activities.

6. Documentation requirements

To support a claim for CPT 99350, 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.
• High level of medical decision making involved.
• Total time spent on the encounter, including face-to-face and non-face-to-face activities.
• Diagnosis and treatment plan.
• Any referrals, consultations, or follow-up appointments needed.

7. Billing guidelines

When billing for CPT code 99350, it is important to follow these guidelines:

• Ensure that the patient is an established patient and the visit takes place at their home or residence.
• Document the medically appropriate history and/or examination performed, as well as the high level of medical decision making involved.
• Record the total time spent on the encounter, including face-to-face and non-face-to-face activities.
• Submit the claim with the appropriate diagnosis codes and any additional codes that may apply, such as prolonged services code 99417 for services 75 minutes or longer.

8. Historical information

CPT 99350 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 99350

Five similar codes to CPT 99350 and how they differentiate are:

• CPT 99347: A lower complexity home visit for established patients, requiring a problem-focused history and examination.
• CPT 99348: A moderate complexity home visit for established patients, requiring an expanded problem-focused history and examination.
• CPT 99349: A higher complexity home visit for established patients, requiring a detailed history and examination.
• CPT 99341: A home visit for new patients, requiring a problem-focused history and examination.
• CPT 99345: A home visit for new patients, requiring a comprehensive history and examination.

10. Examples

Here are 10 detailed examples of CPT code 99350 procedures:

1. A home visit for an established patient with congestive heart failure, requiring a comprehensive history, examination, and high level of medical decision making.
2. An established patient with advanced diabetes requires a home visit for evaluation and management, including a detailed history, examination, and high level of medical decision making.
3. A home visit for an established patient with chronic obstructive pulmonary disease (COPD), requiring a comprehensive history, examination, and high level of medical decision making.
4. An established patient with end-stage renal disease requires a home visit for evaluation and management, including a detailed history, examination, and high level of medical decision making.
5. A home visit for an established patient with multiple sclerosis, requiring a comprehensive history, examination, and high level of medical decision making.
6. An established patient with Parkinson’s disease requires a home visit for evaluation and management, including a detailed history, examination, and high level of medical decision making.
7. A home visit for an established patient with severe arthritis, requiring a comprehensive history, examination, and high level of medical decision making.
8. An established patient with a recent stroke requires a home visit for evaluation and management, including a detailed history, examination, and high level of medical decision making.
9. A home visit for an established patient with advanced cancer, requiring a comprehensive history, examination, and high level of medical decision making.
10. An established patient with a complex wound requires a home visit for evaluation and management, including a detailed history, examination, and high level of medical decision making.