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See a sample rate comparisonCPT 99347 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 Est Sf Mdm 20, Home Or Residence Visit For The Evaluation And Management Of An Established 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 20 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 CG - Policy criteria applied |
| Complexity Level | Low |
| Medicare Fee Schedule | $46.09 national non-facility rate (2026) · View Medicare rates for 99347 |
| Medicaid Fee Schedule | $40.22 median of the 8 states in the free preview · View Medicaid rates for 99347 |
National average reimbursement for CPT 99347 by major payers:
$64.61
$63.31
$54.37
$74.89
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CPT 99347
5 of 25 sample ratesHigher to lower in this preview
Neena Passi
$137.39Published rateTigist Mehari
Summit Healthcare Association
$83.22Published rateAustin Lewis
Healthtexas Provider Network
$56.00Published rateRabab Mohsin
Rabab Mohsin Md PLLC
$44.45Published rateCharlotte Appleton
Trumen Physicians And Associates PLLC
$40.84Published rate
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See a sample payer proposalCPT 99347 vs. Other Home or Residence Services Codes
The CPT 99347 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 99347 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 |
|---|---|---|
| 99347-CPT | Low | Home Res Vst Est Sf Mdm 20, Home Or Residence Visit For The Evaluation And Management Of An Established 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 20 Minutes Must Be Met Or Exceeded |
| 99348-CPT | Low | Home Res Vst Est Low Mdm 30, Home Or Residence Visit For The Evaluation And Management Of An Established 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 |
| 99349-CPT | Moderate | Home Res Vst Est Mod Mdm 40, Home Or Residence Visit For The Evaluation And Management Of An Established 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 40 Minutes Must Be Met Or Exceeded |
| 99350-CPT | High | Home Res Vst Est High Mdm 60, Home Or Residence Visit For The Evaluation And Management Of An Established 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 60 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 99347. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99347 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
To get an estimate for a specific medical procedure, you can use tools that provide pricing information based on CPT codes and your location. For a comprehensive lookup, you can use Payerprice's fee schedule lookup tool, where you can search with a CPT code and your specific location to find relevant pricing data. You can also contact your insurance provider or the healthcare facility directly for an estimate.
CPT stands for Current Procedural Terminology. CPT codes are standardized five-digit codes used by medical professionals to describe and report medical, surgical, and diagnostic services and procedures to payers (like insurance companies). They are crucial for billing and reimbursement, ensuring consistent communication about the services rendered.
Healthcare prices can vary significantly due to several factors, including the type of facility (hospital vs. independent clinic), geographic location, the specific insurance plan negotiated rates, the provider's reputation, and whether the service is in-network or out-of-network. Different payers also negotiate different rates, leading to a wide range of costs for the same service.
To find information about healthcare prices specific to your area and for particular CPT codes, you can utilize tools designed for this purpose. Payerprice offers a fee schedule lookup tool where you can search with a CPT code and your specific location to get relevant pricing information. Additionally, you can check with your insurance provider for their negotiated rates or directly contact healthcare providers in your area for estimates.
If you receive a medical bill that seems too high, first review it carefully for any errors. Compare the services billed with the services you received. Then, contact the billing department of the healthcare provider to request an itemized bill and ask for clarification. You should also contact your insurance company to understand what they covered and why. If discrepancies remain, you can negotiate with the provider for a lower price or look into patient advocacy services.