• Coding Physician Visits in Skilled Nursing Facilities/Nursing Facilities


    As of April 22, due to the COVID-19 public health emergency, CMS is waiving the requirement in 42 CFR 483.30 for physicians and non-physician practitioners to perform in-person visits for nursing home residents and allow visits to be conducted, as appropriate, via telehealth options. Prior to this, telehealth was only available for established patient visits.

    Coding for Skilled Nursing Facility

    • To be reported when the MD, DO, OD visits the patient in the Skilled Nursing Facility.
    • Place of Service is 13.
    • Initial Visit whether patient is new or established 99304, 99305, 99306
    • Subsequent Skilled Nursing Facility visits performed in person or via telehealth: 99307, 99308, 99309, 99310

    Coding for Nursing Home Visits

    • To be reported when the MD, DO, OD visits the patient in a Nursing Home.
    • Place of service is 13
    • New Patient: 99324, 99325, 99326, 99327, 99328
    • Established Patient: 99334, 99335, 99336, 99337
    • Modifier -25

    Note: When billing an intravitreal injection (or any minor surgery) the same day as an encounter, consider the definition of modifier -25 and although medically necessary, if the established patient exam is performed solely to confirm the need for the injection, the exam is not separately billable.

    Coding for Home Visits

    • To be reported when the MD, DO, OD visits the patient at their home.
    • Place of service is 12
    • New Patient: 99341, 99342, 99343, 99344, 99345
    • Established Patient: 99347, 99348, 99349, 99350
    • Modifier -25

    Note: When billing an intravitreal injection (or any minor surgery) the same day as an encounter, consider the definition of modifier -25 and although medically necessary, if the established patient exam is performed solely to confirm the need for the injection, the exam is not separately billable.

    View updates on telemedicine coding to use in your practice based on guidelines from CMS.