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 99316 Fee Schedule
Last Verified: October 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 |
| Common Modifiers | 25 - Significant, separately identifiable E/M service same day SA |
| Complexity Level | Low |
| Medicare Fee Schedule | $138.28 national non-facility rate (2026) · View Medicare rates for 99316 |
| Medicaid Fee Schedule | $123.085 median of the 8 states in the free preview · View Medicaid rates for 99316 |
National average reimbursement for CPT 99316 by major payers:
$141.20
$122.49
$113.18
$167.29
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 99316.
CPT 99316
5 of 25 sample ratesHigher to lower in this preview
Amitabh Gupta
$404.60Published rateSteven Johnson
J.D. Johnson D.O. & Associates
$217.72Published rateSusan Heineck
Third Coast Emergency Physicians Southwest PA
$162.00Published rateMaria De Jesus
Paradigm Neurodiagnostics LLC
$112.08Published ratePrime Medic, P.A.
$80.38Published 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 99316 vs. Other Nursing Facility Services Codes
The CPT 99316 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 99316 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 99316. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99316 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 99316) and we'll show you how you compare in 15 minutes or less.
Frequently Asked Questions
CPT stands for Current Procedural Terminology. CPT codes are a set of medical codes used by physicians, allied health professionals, and hospitals to describe the medical, surgical, and diagnostic services provided to patients. They are essential for billing and for communicating accurate information about medical procedures and services between providers, patients, and payers.
To find the estimated cost of a specific medical procedure or service, you will typically need the CPT code for that service and your specific location. For a robust fee schedule lookup, you can use tools like Payerprice. Payerprice offers a fee schedule lookup tool that allows users to search for prices based on CPT codes and specific locations, helping you understand potential costs before receiving care.
A fee schedule is a comprehensive listing of fees used by insurance companies and government programs (like Medicare) to pay providers for services rendered. It outlines the maximum amount an insurer will reimburse for specific medical procedures and services. Providers often have their own fee schedules, but reimbursements are dictated by the payer's schedule.
These are common terms related to your health insurance plan that impact your out-of-pocket costs: * **Deductible:** The amount you must pay for covered health care services before your insurance plan starts to pay. * **Co-pay (or co-payment):** A fixed amount you pay for a covered health care service after you've paid your deductible (e.g., $20 for a doctor's visit). * **Co-insurance:** Your share of the cost of a covered health care service, calculated as a percentage (e.g., 20%) of the allowed amount for the service after you've paid your deductible. These amounts vary greatly by insurance plan and can significantly affect how much you pay for care.
In-network providers (or participating providers) are healthcare professionals or facilities that have a contract with your health insurance plan. They agree to provide services at certain pre-negotiated rates, which typically results in lower out-of-pocket costs for you. Out-of-network providers are those who do not have a contract with your health insurance plan. If you see an out-of-network provider, your insurance may cover a smaller portion of the cost, or not at all, leading to higher out-of-pocket expenses for you. Some plans (like PPO) offer some coverage for out-of-network, while others (like HMO) generally do not, except in emergencies.