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See a sample rate comparisonCPT 99309 Fee Schedule
Last Verified: September 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.
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
| 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 GW - Condition not related to the patient's terminal condition |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 99309 |
| Medicaid Fee Schedule | View Medicaid rates for 99309 |
National average reimbursement for CPT 99309 by major payers:
$122.19
$95.07
$99.40
$152.87
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CPT 99309
5 of 25 sample ratesHigher to lower in this preview
Tanya Royster
Quincy Physicians & Surgeons Clinic S.C. D/B/A Quincy Medical Group
$221.86Published rateVictoria Yorke
$132.49Published rateKhoa Nguyen
$106.73Published rateAhmed Hussain
Burlington Health Services
$95.26Published ratePaul Schwartz
Paul M. Schwartz, M.D., P.A.
$65.04Published rate
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See a sample payer proposalCPT 99309 vs. Other Nursing Facility Services Codes
The CPT 99309 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 99309 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 99309. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99309 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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