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See a sample rate comparisonCPT 99350 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address high-level medical decision-making, often including multiple diagnoses or prescription management.
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
| 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 | High |
| Medicare Fee Schedule | $193.06 national non-facility rate (2026) · View Medicare rates for 99350 |
| Medicaid Fee Schedule | $157.275 median of the 8 states in the free preview · View Medicaid rates for 99350 |
National average reimbursement for CPT 99350 by major payers:
$219.44
$204.56
$187.83
$265.69
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CPT 99350
5 of 25 sample ratesHigher to lower in this preview
Sabreena Basu
Emory University
$463.36Published rateAndrea Giomi
Texas Health Physicians Group
$349.60Published rateGeetanjali Kumar
Columbus Ambulatory Healthcare Services Inc
$308.89Published rateAvery Strickland
Cooperative Healthcare Services Inc
$199.44Published rateThomas Karisny Md PC
$127.83Published rate
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See a sample payer proposalCPT 99350 vs. Other Home or Residence Services Codes
The CPT 99350 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 99350 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 99350. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99350 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 medical professionals to describe medical, surgical, and diagnostic services. They are crucial for accurate billing and reporting of healthcare services to insurance companies and other payers.
Finding the exact cost of a medical procedure can be complex due to varying factors like your insurance plan, location, and provider. You can start by contacting your insurance company for an estimate, or directly asking your healthcare provider for a good faith estimate. For a more precise cost search using a specific CPT code and your location, you can utilize tools like Payerprice's fee schedule lookup tool.
An in-network provider has a contract with your health insurance company, agreeing to provide services at pre-negotiated rates. This usually results in lower out-of-pocket costs for you. An out-of-network provider does not have such a contract, meaning your insurance may cover a smaller portion of the cost, or none at all, leading to higher out-of-pocket expenses.
Medical costs vary significantly due to a multitude of factors, including geographic location, the specific healthcare provider or facility, the complexity of the procedure, your insurance coverage (and your deductible, copay, and coinsurance), the negotiated rates between providers and insurers, and whether the provider is in-network or out-of-network. Hospital charges for the same service can also differ widely.
To find a specific price for a CPT code in your area, you can use specialized tools designed for this purpose. Payerprice offers a fee schedule lookup tool that allows users to search for costs based on CPT codes and specific locations, helping you get a more accurate estimate for various medical services.