CPT 99310 Fee Schedule

Last Verified: January 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.

Subsequent 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 45 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 • 95 - Telemedicine - audio and video
Complexity Level	High

National average reimbursement for CPT 99310 by major payers:

$174.23

$136.95

$144.51

$227.86

Preview provider-level rates for...

For billing codeCPT 99310

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 99310
United	99310	$180.60	1437218807 - CARLOS MEZA	452498998 - (TX) ADULT INPATIENT MEDICAL SERVICES	TX	Internal Medicine Physician (207R00000X)
United	99310	$295.82	1790006930 - SARAH CROWLEY	222560501 - (MA) MASS GENERAL BRIGHAM INCORPORATED	MA	Pediatrics Physician (208000000X)
United	99310	$225.69	1235517194 - CAMERON SIMONSEN	742967081 - (TX) HILLCREST PHYSICIAN SERVICES	TX	Internal Medicine Physician (207R00000X)
United	99310	$180.17	1447630033 - UGOCHUKWU MADUFORO	271371893	TX	Internal Medicine Physician (207R00000X)
United	99310	$357.51	1265011043 - COLE MARTENS	42807148 - MASS GENERAL BRIGHAM INCORPORATED	MA	Pediatrics Physician (208000000X)
United	99310	$308.07	1033772090 - YING YI ZHANG	43397450 - (MA) ATRIUS HEALTH, INC.	MA	Pediatrics Physician (208000000X)
United	99310	$292.52	1225077084 - CLYDE FORD	760386391 - KELSEY-SEYBOLD MEDICAL GROUP PLLC	TX	Internal Medicine Physician (207R00000X)
United	99310	$225.94	1366424020 - BRIAN SARD	42472758 - (MA) CHILD HEALTH FOUNDATION OF BOSTON INC	MA	Pediatrics Physician (208000000X)
United	99310	$144.02	1639564453 - MARY ILES	860718949 - (AZ) MOUNTAIN VIEW PEDIATRICS, PC	MA	Pediatrics Physician (208000000X)
United	99310	$195.44	1720083892 - MATTHEW MASIELLO	320367841	MA	Pediatrics Physician (208000000X)
United	99310	$213.38	1760428064 - PATTI POWELL	911947573	TX	Internal Medicine Physician (207R00000X)
United	99310	$225.69	1942684840 - RAUL MERCADO GARCIA	742958277 - SCOTT & WHITE CLINIC	TX	Cardiovascular Disease Physician (207RC0000X)
United	99310	$121.76	1891765665 - HEIDI GOMES	454604613 - (GA) PEDIATRIC CENTER FOR WELLNESS	MA	Pediatrics Physician (208000000X)
United	99310	$188.07	1487230058 - DHARAM PATEL	742958277 - SCOTT & WHITE CLINIC	TX	Internal Medicine Physician (207R00000X)
United	99310	$308.07	1124006754 - MICHELE GREENWALD	43397450 - (MA) ATRIUS HEALTH, INC.	MA	Pediatrics Physician (208000000X)
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 99310 vs. Other Nursing Facility Services Codes

The CPT 99310 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 99310 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)
99307-CPT	Low	Subsequent Nursing Facility Care Per Day For The Evaluation And Management Of A Patient Which Requires A Medically Appropriate History And/Or Examination And Straightforward Medical Decision Making. When Using Total Time On The Date Of The Encounter For Code Selection 10 Minutes Must Be Met Or Exceeded. (Desc Rvsd 1/1/23)
99310-CPT	High	Subsequent 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 45 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 99310. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.

Understanding the 99310 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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