CPT 99304 Fee Schedule

Last Verified: November 2025

Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.

Initial Nursing Facility Care Per Day For The Evaluation And Management Of A Patient Which Requires A Medically Appropriate History And/Or Examination And Straightforward Or Low Level Of Medical Decision Making. When Using Total Time On The Date Of The Encounter For Code Selection 25 Minutes Must Be Met Or Exceeded. (Desc Rvsd 1/1/23)

Key Fact	Detail
Service Type	• Evaluation and Management • Nursing Facility Services
Common Place of Service	• 99 - Other POS • None
Common Modifiers	• None • 25 - Significant, separately identifiable E/M service same day • AI - Principal Physician of Record
Complexity Level	Moderate

National average reimbursement for CPT 99304 by major payers:

$101.85

$80.66

$91.29

$132.80

Preview provider-level rates for...

For billing codeCPT 99304

Payer	Code	Rate	NPI	Tax ID	State	Specialty
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 99304
United	99304	$100.00	1881153765 - THEODORE BOSI	363097297 - NORTHWESTERN MEMORIAL HEALTHCARE	FL	Psychiatry Physician (2084P0800X)
United	99304	$116.69	1982717120 - RODNEY EIGER	376000511 - THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS	IL	Psychiatry Physician (2084P0800X)
United	99304	$122.91	1720048572 - JOSHUA NATHAN	205220961 - EDGEWOOD CLINICAL SERVICES	IL	Psychiatry Physician (2084P0800X)
United	99304	$65.00	1518346568 - CLAYTON PARKS	362670036 - GATEWAY FOUNDATION INC	IL	Psychiatry Physician (2084P0800X)
United	99304	$112.87	1902917818 - FAZAL AHMED	366006541 - (IL) VETERANS ASSISTANCE COMMISSION C	IL	Child & Adolescent Psychiatry Physician (2084P0804X)
United	99304	$102.16	1669039822 - DANIEL BOEDER	370661183 - BLESSING HOSPITAL	IL	Child & Adolescent Psychiatry Physician (2084P0804X)
United	99304	$122.91	1528406493 - RUHINA ALI	205220961 - EDGEWOOD CLINICAL SERVICES	IL	Psychiatry Physician (2084P0800X)
United	99304	$80.65	1902043334 - SELEENA SHRESTHA	843229208 - (IL) GATEWAY PROFESSIONAL SERVICES PC	IL	Child & Adolescent Psychiatry Physician (2084P0804X)
United	99304	$80.65	1205917176 - RANDY JUNG	371350408 - (IL) PRAIRIE PSYCHIATRY SC	IL	Psychiatry Physician (2084P0800X)
United	99304	$101.09	1457397903 - RAMAKRISHNA RAO	882121598 - GEODE HEALTH OF TEXAS PLLC	VA	Child & Adolescent Psychiatry Physician (2084P0804X)
United	99304	$132.00	1730263617 - MARK ALTER	910545036 - TRI-STATE MEMORIAL HOSPITAL	IL	Child & Adolescent Psychiatry Physician (2084P0804X)
United	99304	$63.50	1598159709 - RICHARD COCKERILL	1598159709 - (IL) RICHARD COCKERILL	CA	Psychiatry Physician (2084P0800X)
United	99304	$100.00	1255308565 - ALLEN KUO	364468243	IL	Psychiatry Physician (2084P0800X)
United	99304	$100.00	1124697719 - SUSAN GIERCZYK	364026519 - (IL) STILLPOINT MENTAL HEALTH ASSOCIATES S.C.	IL	Psychiatry Physician (2084P0800X)
United	99304	$84.68	1407411689 - POOJA AGARWAL	871959655 - (IL) CHICAGO BH HOSPITAL LLC	IL	Psychiatry Physician (2084P0800X)
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist

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CPT 99304 vs. Other Nursing Facility Services Codes

The CPT 99304 code is part of the Evaluation and Management services used for Nursing Facility Services. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.

The CPT 99304 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.

Code	Complexity	Description
99304	Low	Initial Nursing Facility Care Per Day For The Evaluation And Management Of A Patient Which Requires A Medically Appropriate History And/Or Examination And Straightforward Or Low Level Of Medical Decision Making. When Using Total Time On The Date Of The Encounter For Code Selection 25 Minutes Must Be Met Or Exceeded. (Desc Rvsd 1/1/23)
99305	Moderate	Initial Nursing Facility Care Per Day For The Evaluation And Management Of A 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 35 Minutes Must Be Met Or Exceeded. (Desc Rvsd 1/1/23)
99306	High	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. (Desc Rvsd 1/1/2024)
99307	Low	Subsequent Nursing Facility Care Per Day For The Evaluation And Management Of A Patient Which Requires A Medically Appropriate History And/Or Examination And Straightforward Medical Decision Making. When Using Total Time On The Date Of The Encounter For Code Selection 10 Minutes Must Be Met Or Exceeded. (Desc Rvsd 1/1/23)

What is a fee schedule?

A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 99304. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.

Understanding the 99304 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.

Factors that affect fee schedules

Medicare & Medicaid Rates

Government-set reimbursement amounts

Private Insurance Rates

Negotiated rates between providers and insurance companies

Geographic Location

Costs may be higher in urban areas.

Provider Type

Hospital providers may have different rates than private practice.

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