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See a sample rate comparisonCPT 99345 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 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
| Key Fact | Detail |
|---|---|
| Service Type | Evaluation and Management Home or Residence 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 | Moderate |
| Medicare Fee Schedule | $210.09 national non-facility rate (2026) · View Medicare rates for 99345 |
| Medicaid Fee Schedule | $178.21 median of the 8 states in the free preview · View Medicaid rates for 99345 |
National average reimbursement for CPT 99345 by major payers:
$254.41
$195.06
$221.23
$310.98
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CPT 99345
5 of 25 sample ratesHigher to lower in this preview
Ihab Hajjar
$559.38Published rateChandrini Jayasundera
Seton Family Of Doctors
$341.23Published rateJones County Regional Healthcare System, Stamford Memorial Hospital
Jones County Regional Healthcare System
$277.75Published rateRandi Baculi
Randi H Baculi Md PA
$247.44Published rateAmie Sun-Wright
Mrg Health Texas PLLC
$140.03Published rate
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See a sample payer proposalCPT 99345 vs. Other Home or Residence Services Codes
The CPT 99345 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 99345 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 99345. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99345 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 99345 is an Evaluation and Management code for Home or Residence Services, representing a moderate-complexity encounter. It differs from other home or residence service codes primarily by the increased provider time, moderate medical decision-making, and more detailed documentation requirements it entails. Unlike lower-level codes that require less time and simpler assessments, CPT 99345 typically involves multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement. If you need to understand specific reimbursement rates or compare fee schedules for CPT codes in a particular location, you can use Payerprice's fee schedule lookup tool.