Rate Benchmarking
Compare your rates with similar providers.
Select a published rate, define comparable providers, and see where that rate falls in your market.
See a sample rate comparisonCPT 99307 Fee Schedule
Last Verified: October 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.
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
| 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 CG - Policy criteria applied |
| Complexity Level | Low |
| Medicare Fee Schedule | $42.09 national non-facility rate (2026) · View Medicare rates for 99307 |
| Medicaid Fee Schedule | $34.325 median of the 8 states in the free preview · View Medicaid rates for 99307 |
National average reimbursement for CPT 99307 by major payers:
$52.33
$39.85
$45.66
$70.32
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 99307.
CPT 99307
5 of 25 sample ratesHigher to lower in this preview
Melissa Weaver
Florida Hospital Medical Group Inc
$128.55Published rateMeghann Hennelly
Eastern Maine Medical Center
$73.51Published rateVinod Alluri
Blessing Hospital
$49.90Published rateAftab Poshni
Horizons Behavioral Health LLC
$39.65Published rateDaineysy Gonzalez
The Derm Group LLP
$27.79Published rate
Get a free rate benchmark for your specialty.
Choose your state and specialty to build a report from payer-published rates.
Use market rates to prepare your payer proposal.
Payer Contract Negotiation
Draft a fee schedule renegotiation letter.
Use your fee schedule and market benchmarks to set target rates and draft a letter for your payer.
See a sample payer proposalCPT 99307 vs. Other Nursing Facility Services Codes
The CPT 99307 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 99307 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 |
| 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 |
| 99308-CPT | Low | Sbsq Nf Care Low Mdm 20, Subsequent Nursing Facility Care Per Day For The Evaluation And Management Of A Patient Which Requires A Medically Appropriate History And Or Examination And Low Level Of Medical Decision Making When Using Total Time On The Date Of The Encounter For Code Selection 20 Minutes Must Be Met Or Exceeded |
| 99309-CPT | Moderate | Sbsq Nf Care Moderate Mdm 30, Subsequent 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 30 Minutes Must Be Met Or Exceeded |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 99307. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99307 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 99307) and we'll show you how you compare in 15 minutes or less.
Frequently Asked Questions
CPT 99307 is an Evaluation and Management (E/M) code for Nursing Facility Services, representing a moderate-complexity encounter. It differs from other nursing facility service codes based on the time spent by the provider, the level of medical decision-making (MDM), and the required documentation. Specifically, CPT 99307 involves more provider time and moderate MDM, typically encompassing multiple diagnoses, medication management, or test interpretation. This generally leads to higher reimbursement and more detailed documentation requirements compared to lower-level codes, which involve less time and simpler assessments. For specific fee schedules or reimbursement details for CPT codes in your location, it is recommended to use Payerprice's fee schedule lookup tool.