CPT 99309 Fee Schedule

Last Verified: January 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.

Subsequent Nursing Facility Care Per Day For The Evaluation And Management Of A Patient Whcih Requires A Medically Appropriate History And/Or Examination And Moderate Level Of Medical Making. When Using Total Time On The Date Of The Encounter For Code Selection 30 Minutes Must Be Met Or Exceeded (Desc Rvsd 1/1/23)

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

National average reimbursement for CPT 99309 by major payers:

$122.19

$95.07

$99.40

$152.87

Preview provider-level rates for...

For billing codeCPT 99309

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 99309
United	99309	$106.73	1548271018 - MING XU	872678749 - (IL) YICTORY HEALTH INC	IL	Psychiatry Physician (2084P0800X)
United	99309	$145.89	1962664789 - JAMIE EVANS	364015560 - LOYOLA UNIVERSITY MEDICAL CENTER	NC	Psychiatry Physician (2084P0800X)
United	99309	$210.08	1447264932 - CYNTHIA STACK	363279680 - (IL) PEDIATRIC FACULTY FOUNDATION IN	IL	Neurology with Special Qualifications in Child Neurology Physician (2084N0402X)
United	99309	$170.55	1457847709 - ALEDYANDRA CRESPO NIEVES	260609255 - FLORIDA WOMAN CARE, LLC	FL	Obstetrics & Gynecology Physician (207V00000X)
United	99309	$97.55	1891959086 - CHRISTOPHER DICKINSON	274234147 - (IL) VOHRA WOUND PHYSICIANS OF IL SC	FL	Family Medicine Physician (207Q00000X)
United	99309	$221.86	1851490791 - TANYA ROYSTER	371206525 - QUINCY PHYSICIANS & SURGEONS CLINIC S.C. D/B/A QUINCY MEDICAL GROUP	IL	Child & Adolescent Psychiatry Physician (2084P0804X)
United	99309	$76.76	1477627529 - RIZWANA HAMID	300424479	FL	Internal Medicine Physician (207R00000X)
United	99309	$94.83	1427476456 - LINDA JIANG	111635088 - (NY) MERCY MEDICAL CENTER	FL	Neurology Physician (2084N0400X)
United	99309	$95.26	1679719777 - SUPARNA BASU	853384814	CA	Psychiatry Physician (2084P0800X)
United	99309	$95.26	1396877767 - AHMED HUSSAIN	872947688 - (IL) BURLINGTON HEALTH SERVICES	WI	Psychiatry Physician (2084P0800X)
United	99309	$106.73	1245674159 - KHOA NGUYEN	821701539	NJ	Psychiatry Physician (2084P0800X)
United	99309	$112.08	1679526784 - ELTON SMITH	853384814	NC	Psychiatry Physician (2084P0800X)
United	99309	$112.08	1932433745 - JOAO BUSNELLO	364476817 - (IL) AURORA CHICAGO LAKESHORE HOSPITAL LLC	IL	Psychiatry Physician (2084P0800X)
United	99309	$162.69	1740227503 - CHRISTINA JOHNSON	590634434 - SACRED HEART HEALTH SYSTEM INC	FL	Nurse Practitioner (363L00000X)
United	99309	$92.50	1346714433 - FAIZAL MALKANA	581672987 - (IL) EDWARD HEALTH VENTURES	IL	Psychiatry Physician (2084P0800X)
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

Want to see your competitors' rates?

Start your trial today to unlock complete access to provider rates and fee schedules in your area.

Run a free sample report

Here's what you can do with PayerPrice

Renegotiate your managed care contracts

Benchmark your current rates against market averages to identify opportunities for rate optimization.

Prospect for new business using fee schedules

Access every provider's negotiated rates for every billing code in your market to inform your prospecting strategies.

Integrate real-time payer data into your workflows

Automatically keep fee schedules up-to-date without adding yet another log-in to your insurance systems. Connect via API or SQL.

Explore state-level rates for free

PayerPrice shows you the exact negotiated rates that insurers publish under federal transparency rules.
We display the raw data directly from insurers' files, giving you the same information they make public. Learn more about Price Transparency.

CPT 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	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)
99309-CPT	Moderate	Subsequent Nursing Facility Care Per Day For The Evaluation And Management Of A Patient Whcih Requires A Medically Appropriate History And/Or Examination And Moderate Level Of Medical Making. When Using Total Time On The Date Of The Encounter For Code Selection 30 Minutes Must Be Met Or Exceeded (Desc Rvsd 1/1/23)

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.

FREE SAMPLE MARKET COMPARISON

Let's review your payer contracts side-by-side with the market.

Bring your top codes (like CPT 99309) and we'll show you how you compare in 15 minutes or less.

Schedule a Demo