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 99310 Fee Schedule
Last Verified: October 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.
Sbsq Nf Care High Mdm 45, 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
| 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 95 - Telemedicine - audio and video |
| Complexity Level | High |
| Medicare Fee Schedule | $163.33 national non-facility rate (2026) · View Medicare rates for 99310 |
| Medicaid Fee Schedule | $133.03 median of the 8 states in the free preview · View Medicaid rates for 99310 |
National average reimbursement for CPT 99310 by major payers:
$174.23
$136.95
$144.51
$227.86
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 99310.
CPT 99310
5 of 25 sample ratesHigher to lower in this preview
Cole Martens
Mass General Brigham Incorporated
$357.51Published rateAllison Lander
Abksw Preferred Health Partners
$279.42Published ratePatti Powell
$213.38Published rateRahulkumar Singh
$180.17Published rateKatharine Davidoff
Franciscan Hospital For Children
$98.66Published 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 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 |
|---|---|---|
| 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 |
| 99310-CPT | High | Sbsq Nf Care High Mdm 45, 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 |
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.
FREE SAMPLE MARKET COMPARISON
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 99310) and we'll show you how you compare in 15 minutes or less.
Frequently Asked Questions
To understand the potential cost of a medical procedure, start by contacting your insurance provider to inquire about your coverage, deductible, co-pays, and out-of-pocket maximums. You can also ask the healthcare provider for an estimate. For more detailed and localized pricing information based on CPT codes, you can utilize tools like Payerprice's fee schedule lookup.
CPT (Current Procedural Terminology) codes are a standardized set of five-digit codes used by healthcare providers to describe medical, surgical, and diagnostic services. They are crucial for consistent communication between providers, patients, and insurers. Understanding CPT codes is important for patients because these codes determine how services are billed and, consequently, how much you might pay. When you have a CPT code for a specific service, you can use it to research potential costs.
To look up the price of a specific medical service in your area, you can use online tools that provide fee schedule lookups based on CPT codes and location. Payerprice offers a fee schedule lookup tool where you can search with a specific CPT code and your location to find relevant pricing information. This can help you compare costs and make informed decisions.
A 'billed charge' is the initial amount that a healthcare provider charges for a service, often referred to as the 'list price.' This is typically the highest amount. A 'negotiated rate' (also known as the allowed amount or contracted rate) is the discounted price that an insurance company has agreed upon with a healthcare provider for a specific service. If you have insurance, you generally pay a portion of the negotiated rate, not the billed charge.
Healthcare prices can vary significantly between providers and locations due to several factors. These include differing negotiation agreements with insurance companies, variations in overhead costs (rent, staff salaries, technology), the specific equipment used, the provider's reputation and specialty, regional cost of living differences, and the overall supply and demand for certain services. The lack of price transparency in the healthcare market also contributes to these discrepancies.