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See a sample rate comparisonCPT 99315 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.
Discharge Care Nursing Home, Physician Services For Discharge From Nursing Home. The Amount Of Time The Physician Spends Is Determined By A Persons Condition And Treatment Needs.
| Key Fact | Detail |
|---|---|
| Service Type | Evaluation and Management Nursing Facility Services |
| Common Place of Service | 99 - Other POS None |
| Common Modifiers | None CG - Policy criteria applied SA |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 99315 |
| Medicaid Fee Schedule | View Medicaid rates for 99315 |
National average reimbursement for CPT 99315 by major payers:
$94.44
$86.26
$77.24
$111.72
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CPT 99315
5 of 25 sample ratesHigher to lower in this preview
Andrea Urban
Holliston Pediatric Group, Inc.
$205.69Published rateYu-Hsuan Liao
Catholic Medical Center
$136.27Published rateSima Shahbandar
$85.18Published rateFonda Chan
Neurology Consultants Of Dallas, P.A.
$63.50Published rateGina Desanto
$47.70Published rate
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See a sample payer proposalCPT 99315 vs. Other Nursing Facility Services Codes
The CPT 99315 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 99315 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 |
|---|---|---|
| 99306-CPT | High | 1st Nf Care High Mdm 50, 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 |
| 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 |
| 99315-CPT | Low | Discharge Care Nursing Home, Physician Services For Discharge From Nursing Home. The Amount Of Time The Physician Spends Is Determined By A Persons Condition And Treatment Needs. |
| 99316-CPT | Low | Discharge Care Nursing Home, Physician Services For Discharge From Nursing Home. The Amount Of Time The Physician Spends Is Determined By A Persons Condition And Treatment Needs. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 99315. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99315 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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