CMS October 2026Physician Fee Schedule · Free lookup

CPT 99304 Medicare Fee Schedule 2026

Medicare's 2026 national payment for CPT 99304 is $81.16 in a non-facility setting ($71.14 in a facility), up 4.5% from $77.63 in 2025.

National rate, October 2026

Non-facility: $81.16
Facility: $71.14
vs. 2025: +4.5%
Commercial national avg.: $101.65

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HCPCS Codes

99304

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Year

20262025

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Physician Fee Schedule·99304·National·2026, 2025

Current non-facility rate

$81.16▲0.0%

Facility: $71.14

Recent trend

Code description

Medical Care, Initial Nursing Facility Care Per Day For The Evaluation And Management Of A Patient Which Requires These 3 Key Components: A Detailed Or Comprehensive History; A Detailed Or Comprehensive Examination; And Medical Decision Making That Is Straightforward Or Of Low 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

Code	Date	State	Non-Facility Fee	Facility Fee	Description
99304	10/2026	N/A	$81.16	$71.14	Medical Care, Initial Nursing Facility Care Per Day For The Evaluation And Management Of A Patient Which Requires These 3 Key Components: A Detailed Or Comprehensive History; A Detailed Or Comprehensive Examination; And Medical Decision Making That Is Straightforward Or Of Low 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
99304	7/2026	N/A	$81.16	$71.14	Medical Care, Initial Nursing Facility Care Per Day For The Evaluation And Management Of A Patient Which Requires These 3 Key Components: A Detailed Or Comprehensive History; A Detailed Or Comprehensive Examination; And Medical Decision Making That Is Straightforward Or Of Low 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
99304	4/2026	N/A	$81.16	$71.14	Medical Care, Initial Nursing Facility Care Per Day For The Evaluation And Management Of A Patient Which Requires These 3 Key Components: A Detailed Or Comprehensive History; A Detailed Or Comprehensive Examination; And Medical Decision Making That Is Straightforward Or Of Low 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
99304	1/2026	N/A	$81.16	$71.14	Medical Care, Initial Nursing Facility Care Per Day For The Evaluation And Management Of A Patient Which Requires These 3 Key Components: A Detailed Or Comprehensive History; A Detailed Or Comprehensive Examination; And Medical Decision Making That Is Straightforward Or Of Low 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
99304	10/2025	N/A	$77.63	$77.63	Medical Care, Initial Nursing Facility Care Per Day For The Evaluation And Management Of A Patient Which Requires These 3 Key Components: A Detailed Or Comprehensive History; A Detailed Or Comprehensive Examination; And Medical Decision Making That Is Straightforward Or Of Low 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
99304	7/2025	N/A	$77.63	$77.63	Medical Care, Initial Nursing Facility Care Per Day For The Evaluation And Management Of A Patient Which Requires These 3 Key Components: A Detailed Or Comprehensive History; A Detailed Or Comprehensive Examination; And Medical Decision Making That Is Straightforward Or Of Low 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
99304	4/2025	N/A	$77.63	$77.63	Medical Care, Initial Nursing Facility Care Per Day For The Evaluation And Management Of A Patient Which Requires These 3 Key Components: A Detailed Or Comprehensive History; A Detailed Or Comprehensive Examination; And Medical Decision Making That Is Straightforward Or Of Low 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
99304	1/2025	N/A	$77.63	$77.63	Medical Care, Initial Nursing Facility Care Per Day For The Evaluation And Management Of A Patient Which Requires These 3 Key Components: A Detailed Or Comprehensive History; A Detailed Or Comprehensive Examination; And Medical Decision Making That Is Straightforward Or Of Low 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

99304 national rate by year

Each row is the latest CMS file published that year. Change is against the year before.

CMS file	Non-facility	Facility	Change
October 2026	$81.16	$71.14	+4.5%
October 2025	$77.63	$77.63	-2.4%
March 2024	$79.56	$79.56	-1.4%
January 2023	$80.65	$80.65	-9.3%
July 2022	$88.94	$88.94	-

This is the national amount before geographic adjustment. Medicare multiplies each relative value unit by its locality's geographic practice cost index, so a practice's own allowed amount can be higher or lower; pick a state above to see its localities. The facility amount applies when the service is performed in a hospital or other facility setting.

99304: Medicare vs. commercial national average

The commercial national average for 99304, the mean of what BCBS, UnitedHealthcare, Aetna and Cigna publish nationwide, is $101.65, 125% of Medicare's $81.16.

BCBS $101.85
UnitedHealthcare $80.66
Aetna $91.29
Cigna $132.80

A national average, not a local rate: each payer's figure averages the unmodified, in-network professional rates it publishes for 99304 across the country in its transparency files. Contracted rates vary widely by market, provider and plan. Medicare's figure is its national non-facility amount before geographic adjustment.

See commercial rates in your market Commercial rates for 99304

Nearby codes

99305 Medicare rate 99306 Medicare rate 99307 Medicare rate 99308 Medicare rate 99309 Medicare rate 99310 Medicare rate

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Medicaid comparison

See what state Medicaid programs pay for 99304

50 state Medicaid agencies publish their own physician fee schedule. The 99304 page shows real published rates for several of them free, with effective dates and official sources.

17,674 codes and 974,327 published rates, taken from the files the state agencies publish themselves.

See Medicaid rates for 99304

$140.95

993061st Nf Care High Mdm 50, Initial Nursing Facility Care Per Day For The Evaluation And Management Of A 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 50 Minutes Must Be Met Or Exceeded

$193.06

99307Medical Care, Subsequent Nursing Facility Care Per Day For The Evaluation And Management Of A Patient Which Requires At Least 2 Of These 3 Key Components: A Problem Focused Interval History; A Problem Focused Examination; Straightforward Medical Decision Making. 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 Patients And/Or Familys

$42.09

Methodology

Rates are sourced directly from CMS Physician Fee Schedule files, indexed quarterly. Non-facility and facility prices are calculated using the published GPCI for each locality and the year's conversion factor.

View CMS Physician Fee Schedule