What is CPT code 99306?

CPT code 99306 is used by healthcare providers to document and receive reimbursement for initial nursing facility care visits that require a medically appropriate history and/or examination and high-level medical decision-making. It represents a moderate-complexity encounter.

What factors affect the fee schedule for CPT 99306?

Factors affecting the fee schedule for CPT 99306 include Medicare & Medicaid rates (government-set), private insurance negotiated rates, geographic location (costs may be higher in urban areas), and provider type (e.g., hospital vs. private practice).

How does CPT 99306 compare to other nursing facility codes like 99304 or 99305?

CPT 99306 represents a high level of medical decision making and typically involves more provider time (50 minutes or more) compared to 99304 (low complexity, 25 minutes) and 99305 (moderate complexity, 35 minutes). It is used for more complex cases involving multiple diagnoses or medication management.

How can I find out the cost of a specific medical procedure or service?

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.

What is a CPT code and why is it important for understanding healthcare costs?

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.

Does my geographical location impact the cost of healthcare services, and how can I check prices in my area?

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.

Where can I find transparent fee schedules for various medical services?

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.

Can I compare prices for the same healthcare service from different providers or facilities?

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.

CPT 99306 Fee Schedule

Last Verified: July 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	New or Established Patient Initial Nursing Facility Care
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	High
Medicare Fee Schedule	View Medicare rates for 99306

National average reimbursement for CPT 99306 by major payers:

$205.01

$165.21

$177.93

$257.40

Preview provider-level rates for...

For billing codeCPT 99306

Payer	Code	Rate	NPI	Tax ID	State	Specialty
United	99306	$324.33	1336312271 - JOANNE CHANG	223376459 - HACKENSACK MERIDIAN HEALTH MEDICAL GROUP-SPECIALTY CARE PC	NJ	Obstetrics & Gynecology Physician (207V00000X)
United	99306	$92.27	1700832649 - TONI CENTANNI	221893909 - PHYSICIANS FOR WOMEN, P.A.	NJ	Obstetrics & Gynecology Physician (207V00000X)
United	99306	$208.17	1023187143 - ALYSSA BECKER	452548322 - MEDICAL ASSOCIATES OF ENGLEWOOD PC	NJ	Internal Medicine Physician (207R00000X)
United	99306	$178.82	1710031984 - SUNCOAST INTERNAL MEDICINE CONSULTANTS, P.A.	591273247 - (FL) SUNCOAST INTERNAL MEDICINE CONSULTANTS, P.A.	FL	Internal Medicine Physician (207R00000X)
United	99306	$184.79	1356730881 - MOHAMMAD THAWABI	351183155 - UNIVERSITY MEDICAL DIAGNOSTIC ASSOCIATES INC	NJ	Cardiovascular Disease Physician (207RC0000X)
United	99306	$111.37	1053502229 - VANITA PATEL	450820866 - ATLANTIC OBGYN ASSOCIATES PC	NJ	Obstetrics & Gynecology Physician (207V00000X)
United	99306	$167.70	1578765863 - MINI BALAJI	264203938 - PRINCETON HEALTHCARE AFFILIATED PHYSICIANS PC	NJ	Internal Medicine Physician (207R00000X)
United	99306	$156.92	1699750158 - MOHAMMAD JAVED	10658404 - CARDIOVASCULAR ASSOCIATES OF HUDSON COUNTY, P.A.	NJ	Cardiovascular Disease Physician (207RC0000X)
United	99306	$116.53	1184844045 - LYNNE ACIERNO	204904872 - METROPOLITAN FAMILY HEALTH NETWORK INC	NJ	Internal Medicine Physician (207R00000X)
United	99306	$148.32	1659359263 - JOHN KIM	272047451 - JOHN KIM MD MED GERIATRICS LLC	NJ	Internal Medicine Physician (207R00000X)
United	99306	$134.24	1861690380 - OLENA STEPANYUK	263832744 - IPC HOSPITALIST PHYSICIANS OF NEW JERSEY PC	NJ	Internal Medicine Physician (207R00000X)
United	99306	$137.25	1497135529 - MARTIN CASTANEDA	833167245 - (FL) WOMENS OB GYN CARE LLC	FL	Obstetrics & Gynecology Physician (207V00000X)
United	99306	$148.32	1801878269 - LUIS BENALCAZAR	201760960 - CENTER FOR DIAGNOSIS & TREATMENT LLC	NJ	Internal Medicine Physician (207R00000X)
United	99306	$131.02	1013398650 - KATIE FLOWER	721335958 - (LA) THIBODAUX REGIONAL NETWORK DEVELOPMENT CORPORATION	FL	Surgery Physician (208600000X)
United	99306	$123.60	1912931544 - LEKHRAJ LALA	222586664 - LALA LEKHRAJ	NJ	Cardiovascular Disease Physician (207RC0000X)
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 99306 vs. Other Initial Nursing Facility Care Codes

The CPT 99306 code is part of the New or Established Patient services used for Initial Nursing Facility Care. 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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