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June 10, 2024

Billing Reminders for Codes 99304-99310

Medicare physicians and practitioners are reminded that codes 99304-99310 are once a day codes per IOM 100-04, Chapter 12, Section 30.6.13 (B)External PDF.

B. Visits to Comply With Federal Regulations (42 CFR 483.40 (c) (1)) in the SNF and NF

Payment is made under the physician fee schedule by Medicare Part B for federally mandated visits. Following the initial federally mandated visit by the physician or qualified NPP where permitted, payment shall be made for federally mandated visits that monitor and evaluate residents at least once every 30 days for the first 90 days after admission and at least once every 60 days thereafter. Effective January 1, 2006, the Subsequent Nursing Facility Care, per day, codes 99311- 99313 are deleted. Beginning January 1, 2006, the new CPT codes, Subsequent Nursing Facility Care, per day, (99307 - 99310) shall be used to report federally mandated physician E/M visits and medically necessary E/M visits.

A/B MACs (B) shall not pay for more than one E/M visit performed by the physician or qualified NPP for the same patient on the same date of service. The Nursing Facility Services codes represent a “per day” service.

Medicare Claims Processing Manual External PDF


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