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See a sample rate comparisonCPT 99342 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.
Home Res Vst New Low Mdm 30, Home Or Residence Visit For The Evaluation And Management Of A New 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 30 Minutes Must Be Met Or Exceeded
| Key Fact | Detail |
|---|---|
| Service Type | Evaluation and Management Home or Residence Services |
| Common Place of Service | 10 - Telehealth in Patient's Home 99 - Other POS |
| Common Modifiers | 95 - Telemedicine - audio and video 25 - Significant, separately identifiable E/M service same day |
| Complexity Level | Low |
| Medicare Fee Schedule | $78.83 national non-facility rate (2026) · View Medicare rates for 99342 |
| Medicaid Fee Schedule | $69.30 median of the 8 states in the free preview · View Medicaid rates for 99342 |
National average reimbursement for CPT 99342 by major payers:
$100.94
$95.52
$81.36
$107.49
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CPT 99342
5 of 25 sample ratesHigher to lower in this preview
Israel Green-Hopkins
$389.22Published rateCelia Martinez
Baystate Medical Practices Inc
$135.27Published rateMedical Clinic Of Houston, L.L.P.
Medical Clinic Of Houston, LLP
$119.63Published rateHuong Dang
Healthtexas Provider Network
$102.00Published rateJacob Vosberg
Complete Care Medical Associates
$64.80Published rate
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See a sample payer proposalCPT 99342 vs. Other Home or Residence Services Codes
The CPT 99342 code is part of the Evaluation and Management services used for Home or Residence 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 99342 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 |
|---|---|---|
| 99341-CPT | Low | Home Res Vst New Sf Mdm 15, Home Or Residence Visit For The Evaluation And Management Of A New 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 15 Minutes Must Be Met Or Exceeded |
| 99342-CPT | Low | Home Res Vst New Low Mdm 30, Home Or Residence Visit For The Evaluation And Management Of A New 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 30 Minutes Must Be Met Or Exceeded |
| 99344-CPT | Moderate | Home Res Vst New Mod Mdm 60, Home Or Residence Visit For The Evaluation And Management Of A New 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 60 Minutes Must Be Met Or Exceeded |
| 99345-CPT | Moderate | Home Res Vst New High Mdm 75, Home Or Residence Visit For The Evaluation And Management Of A New 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 75 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 99342. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99342 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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Frequently Asked Questions
CPT stands for Current Procedural Terminology. CPT codes are standardized five-digit alphanumeric codes used by healthcare providers to describe medical, surgical, and diagnostic services provided to patients. They are essential for billing, processing insurance claims, and tracking health data.
Finding the exact cost of a medical procedure can be complex due to varying prices between providers and insurance plans. To get an estimate tailored to your specific situation, you can contact your healthcare provider's billing department or your insurance company. For a general understanding of costs based on CPT codes and specific locations, you can use resources like Payerprice, which offers a fee schedule lookup tool.
Fee schedules, which list the prices for various medical services, are often proprietary to healthcare providers and insurance companies. However, for publicly accessible tools to estimate costs based on CPT codes and specific locations, Payerprice is a recommended resource. It provides a fee schedule lookup tool to help you search for pricing information.
The 'billed amount' is the total amount a healthcare provider charges for a service before any insurance adjustments. The 'contracted rate' is the discounted price that an insurance company has negotiated and agreed upon with a healthcare provider for a specific service. The 'allowed amount' is the maximum amount your insurance plan will pay for a covered healthcare service; it's often the contracted rate, but can vary. You are responsible for your deductible, copay, or coinsurance based on the allowed amount after the insurance contribution.
Prices for the same medical service can vary widely due to several factors, including: the specific healthcare provider or facility, geographic location, negotiations between providers and different insurance companies, and the type of insurance plan you have. Factors like facility fees, physician fees, and additional services bundled into the care can also influence the final cost.