CPT 99304 Fee Schedule

Last Verified: March 2026

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	Low
Medicare Fee Schedule	View Medicare rates for 99304

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	$100.30	1659802148 - SARAH MENNELLA	843213629	IL	Psychiatry Physician (2084P0800X)
United	99304	$102.16	1215025309 - DEBORAH GARRELTS-DAOUD	370661183 - BLESSING HOSPITAL	IA	Psychiatry Physician (2084P0800X)
United	99304	$100.00	1124697719 - SUSAN GIERCZYK	364026519 - (IL) STILLPOINT MENTAL HEALTH ASSOCIATES S.C.	IL	Psychiatry Physician (2084P0800X)
United	99304	$325.16	1811275076 - NOURELDIN ABDELHAMID	941156581 - SUTTER BAY MEDICAL FOUNDATION	FL	Neurology Physician (2084N0400X)
United	99304	$76.62	1750794087 - ADITYA VORA	351972384 - PARKVIEW HEALTH SYSTEM INC	FL	Psychiatry Physician (2084P0800X)
United	99304	$168.24	1750680120 - REKHA KASI	911780160	IL	Psychiatry Physician (2084P0800X)
United	99304	$96.62	1073548863 - KIMBERLY HOOD	882517801 - (CA) MOCHI MEDICAL PA	FL	Obstetrics & Gynecology Physician (207V00000X)
United	99304	$66.54	1568668176 - EDGAR HERNANDEZ	843213629	DC	Psychiatry Physician (2084P0800X)
United	99304	$142.57	1699018317 - BIRJU PATEL	362739299 - TRINITY MEDICAL CENTER	IL	Child & Adolescent Psychiatry Physician (2084P0804X)
United	99304	$68.84	1255726865 - NIRAJ PATEL	871793632	FL	Family Medicine Physician (207Q00000X)
United	99304	$102.16	1669039822 - DANIEL BOEDER	370661183 - BLESSING HOSPITAL	IL	Child & Adolescent Psychiatry Physician (2084P0804X)
United	99304	$112.87	1902917818 - FAZAL AHMED	366006541 - (IL) VETERANS ASSISTANCE COMMISSION C	IL	Child & Adolescent Psychiatry Physician (2084P0804X)
United	99304	$78.30	1205026820 - LEOPOLDO CATALA	650667458 - (FL) MIAMI INSTITUTE FOR JOINT RECONSTRUCTION	FL	Physician Assistant (363A00000X)
United	99304	$195.89	1922433440 - SEEMA AHMED	811291017 - (FL) WOMENS HEALTH HOSPITALISTS LLC	FL	Obstetrics & Gynecology Physician (207V00000X)
United	99304	$119.67	1851768337 - KELLY RIDGES	362925195 - ALLERGY & ASTHMA OF DUPAGE, S.C.	IL	Family Nurse Practitioner (363LF0000X)
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

Want to see your competitors' rates?

Start your trial today to unlock complete access to provider rates and fee schedules in your area.

Run a free sample report

Here's what you can do with PayerPrice

Renegotiate your managed care contracts

Benchmark your current rates against market averages to identify opportunities for rate optimization.

Prospect for new business using fee schedules

Access every provider's negotiated rates for every billing code in your market to inform your prospecting strategies.

Integrate real-time payer data into your workflows

Automatically keep fee schedules up-to-date without adding yet another log-in to your insurance systems. Connect via API or SQL.

Explore state-level rates for free

PayerPrice shows you the exact negotiated rates that insurers publish under federal transparency rules.
We display the raw data directly from insurers' files, giving you the same information they make public. Learn more about Price Transparency.

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-CPT	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-CPT	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-CPT	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-CPT	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.

FREE SAMPLE MARKET COMPARISON

Let's review your payer contracts side-by-side with the market.

Bring your top codes (like CPT 99304) and we'll show you how you compare in 15 minutes or less.

Schedule a Demo