cpt 99306, cpt code 99306, 99306 cpt code

CPT Code 99306 | Description, Procedure & Billing Guidelines (2022)

The 99306 CPT code may be used for initial care for submitted nursing facility patients if the three key components are met. 

1. What Is CPT Code 99306?

CPT 99306 can be used for patients receiving initial nursing facility care. However, this code can only be billed if the three key components (as defined by the official description below) are met.

The key components are a medical necessity of the 99306 CPT code procedure.

2. Description

CPT describes the 99306 CPT code as: Initial nursing facility care, per day, for the evaluation and management of a patient, which requires these three key components:

  1. A comprehensive history;
  2. A comprehensive examination; and
  3. Medical decision-making of high complexity.

Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs.

Usually, the problem(s) requiring admission are of high severity. Typically, 45 minutes are spent at the bedside and on the patient’s facility floor or unit.”

3. Procedure

The 99306 CPT code procedure starts with a provider performing initial care in a nursing facility.

This procedure takes an average of 45 minutes and needs to be performed face-to-face with the submitted patient or on the same floor/unit.

The provider needs to perform the following three key components during this procedure:

  1. Medical decision-making of high complexity;
  2. A comprehensive examination; and
  3. A comprehensive history.

TIP: You can find all the CPT codes for initial nursing facility care here.

4. Billing Guidelines

You can bill CPT code 99306 only once per day.

The appropriate service level for the 99306 CPT code is based on the medical necessity of performing the key components. Documentation of the key criteria of the history, exam, and medical-decision making, MDM, elements is also considered.

You can report CPT 99306 if more than 50% of the total time is used for coordination and counseling of care.

5. Resources

CPT Professional 2022

https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=57724&ver=4

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