CPT 99316 is a medical billing code used by healthcare providers to document and receive reimbursement for nursing facility discharge management. It applies to encounters lasting more than 30 minutes and involves moderate-level medical decision-making, often including multiple diagnoses or prescription management.

What factors influence CPT fee schedules?

Several factors affect fee schedules, including Medicare & Medicaid government-set rates, private insurance negotiated rates between providers and companies, geographic location where costs may be higher in urban areas, and provider type (e.g., hospital vs. private practice).

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.

How can I find the cost of a specific medical procedure or service?

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.

How do deductibles, co-pays, and co-insurance affect my out-of-pocket costs?

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.

What's the difference between in-network and out-of-network providers?

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.

CPT 99316 Fee Schedule

Q: How does CPT 99316 compare to other nursing facility service codes?

CPT 99316 is part of the Evaluation and Management services for Nursing Facility Services, representing a moderate-complexity encounter. It 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.

Last Verified: July 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	Nursing Facility Discharge Services Nursing Facility Services
Common Place of Service	99 - Other POS None
Common Modifiers	None 25 - Significant, separately identifiable E/M service same day SA
Complexity Level	Low
Medicare Fee Schedule	View Medicare rates for 99316

National average reimbursement for CPT 99316 by major payers:

$141.20

$122.49

$113.18

$167.29

Preview provider-level rates for...

For billing codeCPT 99316

Payer	Code	Rate	NPI	Tax ID	State	Specialty
United	99316	$294.64	1548261993 - MICHAEL FREIBERGER	43427393 - (MA) WALPOLE PEDIATRIC ASSOCIATES, INC.	MA	Pediatrics Physician (208000000X)
United	99316	$211.88	1891182606 - HEATHER BERNARD	540620889 - INOVA HEALTH CARE SERVICES	MA	Pediatrics Physician (208000000X)
United	99316	$80.38	1255432829 - PRIME MEDIC, P.A.	760586988 - (TX) PRIME MEDIC, P.A.	TX	Internal Medicine Physician (207R00000X)
United	99316	$217.72	1356302277 - STEVEN JOHNSON	263026206 - (TX) J.D. JOHNSON D.O. & ASSOCIATES	TX	Internal Medicine Physician (207R00000X)
United	99316	$167.38	1790093797 - GEORGE MAIDAA	550483245 - PRINCETON COMMUNITY HOSPITAL ASSN INC	TX	Internal Medicine Physician (207R00000X)
United	99316	$204.72	1417392846 - WILLIAM FEINGOLD	752536818 - HEALTHTEXAS PROVIDER NETWORK	TX	Internal Medicine Physician (207R00000X)
United	99316	$170.47	1578845574 - ANA MARIA CALDERON	202148889 - (TX) HEALTHTEXAS MEDICAL GROUP	TX	Internal Medicine Physician (207R00000X)
United	99316	$162.00	1245345610 - SUSAN HEINECK	742931198 - (TX) THIRD COAST EMERGENCY PHYSICIANS SOUTHWEST PA	TX	Internal Medicine Physician (207R00000X)
United	99316	$217.72	1861414005 - NHU TRAN	421761542 - (TX) HEALING COMPANION MEDICAL CLINIC PLLC	TX	Internal Medicine Physician (207R00000X)
United	99316	$273.01	1952335416 - LOUANN MAFFEI-IWUC	42472266 - (MA) RELIANT MEDICAL GROUP, INC.	MA	Pediatrics Physician (208000000X)
United	99316	$103.05	1306987474 - MUSTAFA MOAZAM	274687405 - (CO) MOAZAM PA	TX	Internal Medicine Physician (207R00000X)
United	99316	$122.70	1932294469 - SARITHA DODLA	463116406 - (TX) EXCEL CARDIAC CARE PLLC	TX	Cardiovascular Disease Physician (207RC0000X)
United	99316	$273.01	1861056111 - SARAH GHABBOUR	42472266 - (MA) RELIANT MEDICAL GROUP, INC.	MA	Pediatrics Physician (208000000X)
United	99316	$349.13	1003345919 - ALYSSA LEVIN-SCHERZ	43400617 - TUFTS MEDICAL CENTER PARENT INC	MA	Pediatrics Physician (208000000X)
United	99316	$96.47	1750303863 - MICHAEL OLATUNJI	872096272 - (TX) ACCURA HEALTH II LLC	TX	Internal Medicine Physician (207R00000X)
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 99316 vs. Other Nursing Facility Services Codes

The CPT 99316 code is part of the Nursing Facility Discharge Services 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
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
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.

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