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See a sample rate comparisonCPT 99306 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address high-level medical decision-making, often including multiple diagnoses or prescription management.
1st 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
| Key Fact | Detail |
|---|---|
| Service Type | Evaluation and Management Nursing Facility Services |
| Common Place of Service | 99 - Other POS |
| Common Modifiers | 25 - Significant, separately identifiable E/M service same day AI - Principal Physician of Record |
| Complexity Level | High |
| Medicare Fee Schedule | $193.06 national non-facility rate (2026) · View Medicare rates for 99306 |
| Medicaid Fee Schedule | $157.40 median of the 8 states in the free preview · View Medicaid rates for 99306 |
National average reimbursement for CPT 99306 by major payers:
$205.01
$165.21
$177.93
$257.40
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CPT 99306
5 of 25 sample ratesHigher to lower in this preview
Rosario Ligresti
Hackensack Meridian Health Medical Group-Specialty Care PC
$348.50Published rateMohammad Thawabi
University Medical Diagnostic Associates Inc
$184.79Published rateJohn Kim
John Kim Md Med Geriatrics LLC
$148.32Published rateLekhraj Lala
Lala Lekhraj
$123.60Published rateToni Centanni
Physicians For Women, P.A.
$92.27Published rate
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See a sample payer proposalCPT 99306 vs. Other Nursing Facility Services Codes
The CPT 99306 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 99306 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 | 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 |
| 99305-CPT | Moderate | 1st Nf Care Moderate Mdm 35, 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 |
| 99306-CPT | High | 1st 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 |
| 99307-CPT | Low | Medical 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 |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 99306. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99306 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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Frequently Asked Questions
To find out the cost of a specific medical procedure or service, especially for your particular situation, you can use specialized tools. Payerprice offers a fee schedule lookup tool where you can search by CPT code and specific location to get detailed pricing information.
CPT stands for Current Procedural Terminology. CPT codes are standardized five-digit codes that describe medical, surgical, and diagnostic services and procedures. They are crucial for understanding healthcare costs because they allow you to identify and search for the specific service you are interested in. You can use CPT codes with tools like Payerprice's fee schedule lookup to find pricing tailored to your location.
Yes, your geographical location significantly impacts the cost of healthcare services due to varying labor costs, facility expenses, and local market rates. To check prices in your specific area, you should use a tool that allows for location-based searches. Payerprice offers a fee schedule lookup tool where you can input a CPT code and your specific location to find relevant pricing.
For transparent fee schedules and to understand the pricing of various medical services, especially customized to your situation, it's best to use dedicated lookup tools. Payerprice provides a fee schedule lookup tool that enables users to search with a CPT code and specific location to access comprehensive pricing data.
Comparing prices for the same healthcare service from different providers or facilities is key to making informed decisions. To do this effectively for your specific situation, you should utilize tools designed for this purpose. Payerprice's fee schedule lookup tool allows you to search for services by CPT code and location, giving you the ability to compare potential costs from various sources in your area.