CPT 99308 Fee Schedule
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.
| 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 • CG - Policy criteria applied |
| Complexity Level | Low |
National average reimbursement for CPT 99308 by major payers:
$88.45
$68.45
$74.24
$112.77
| 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 99308 | ||||||
United | 99308 | $98.18 | 1134885163 - JUSTIN MASUD | 591707138 - (FL) CLEARWATER CARDIOVASCULAR AND INTERVENTIONAL CONSULTANTS, MD, PA | FL | Physician Assistant (363A00000X) |
United | 99308 | $59.61 | 1215784285 - WEST POINT MEDICAL ASSOCIATES LLC | 992858527 - (FL) WEST POINT MEDICAL ASSOCIATES LLC | FL | Internal Medicine Physician (207R00000X) |
United | 99308 | $89.65 | 1518012590 - LAURA LONG | 843213629 | IL | Psychiatry Physician (2084P0800X) |
United | 99308 | $61.70 | 1508846866 - AUDREY LEWERENZ-WALSH | 611912933 | FL | Family Medicine Physician (207Q00000X) |
United | 99308 | $66.54 | 1942392212 - ATUL SHETH | 223500420 - CENTER FOR FAMILY GUIDANCE, PC | IL | Psychiatry Physician (2084P0800X) |
United | 99308 | $160.58 | 1740505569 - MEGHAN O'NEILL | 363279680 - (IL) PEDIATRIC FACULTY FOUNDATION IN | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 99308 | $135.71 | 1962664789 - JAMIE EVANS | 910844563 | WI | Psychiatry Physician (2084P0800X) |
United | 99308 | $79.45 | 1720787641 - KOURTNEY RUFF | 882121598 - GEODE HEALTH OF TEXAS PLLC | FL | Physician Assistant (363A00000X) |
United | 99308 | $87.26 | 1144329764 - CHARLES BURDA | 362276984 - ADVENTIST MIDWEST HEALTH | IL | Psychiatry Physician (2084P0800X) |
United | 99308 | $78.27 | 1962664789 - JAMIE EVANS | 331075317 - NCHMD INC | IL | Psychiatry Physician (2084P0800X) |
United | 99308 | $107.66 | 1215968755 - STACEY OCCOMY | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IN | Psychiatry Physician (2084P0800X) |
United | 99308 | $43.15 | 1417913187 - JONATHAN FOX | 650338031 - (FL) PHYSICIANS ASSOCIATES LLC | FL | Family Medicine Physician (207Q00000X) |
United | 99308 | $70.12 | 1316064504 - TRICE LININGER | 870408859 - (FL) OPTUMCARE FLORIDA, LLC | FL | Nurse Practitioner (363L00000X) |
United | 99308 | $52.50 | 1437199494 - JULIAN MOORE | 591671640 - (FL) FLORIDA COMMUNITY HEALTH CENTERS INC | FL | Family Medicine Physician (207Q00000X) |
United | 99308 | $116.62 | 1972863827 - KEVIN JOHNSON | 650512900 - SMH PHYSICIAN SERVICES INC | FL | Internal Medicine Physician (207R00000X) |
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 99308 vs. Other Nursing Facility Services Codes
The CPT 99308 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 99308 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) |
| 99308-CPT | Low | Subsequent Nursing Facility Care Per Day For The Evaluation And Management Of A Patient Whcih 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. (Desc Rvsd 1/1/2024) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 99308. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99308 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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