CPT® Code 99345 is used to report a comprehensive home visit for a new patient presenting with an unstable condition or a significant new medical problem, where the total face-to-face time with the patient is approximately 75 minutes. This code captures the intensity, complexity, and time required to assess, manage, and coordinate care for patients who cannot be seen in a traditional office setting due to mobility, acute illness, or other limitations.
Home visits are a critical component of patient-centered care, allowing clinicians to evaluate environmental factors, functional status, and social determinants of health that can impact diagnosis and treatment planning. This service is distinct from office visits and reflects the additional resources and time required to provide care outside a clinical setting.
Key facts about CPT Code 99345
Service type: Home visit evaluation and management (E/M)
Provider type: Physicians and qualified healthcare professionals
Medical services included: Yes—comprehensive assessment and management of a new patient with an unstable or significant new problem
Typical duration: 75 minutes of face-to-face patient care
Common clinical indications:
- Acute exacerbation of chronic illness (e.g., heart failure, COPD)
- New, serious medical problems requiring urgent assessment
- Patients with mobility issues or homebound status
- Complex medication management or care coordination
- Social, environmental, or safety assessment impacting health outcomes
When to use CPT Code 99345
CPT 99345 is appropriate when:
- The patient is new to the practice and cannot easily attend an office visit
- The patient presents with an unstable condition or significant new problem
- The total face-to-face time with the patient is approximately 75 minutes
- The service includes comprehensive evaluation, history, examination, counseling, and care coordination
- Documentation reflects medical necessity for a home visit
Examples include evaluating a patient recently discharged from the hospital with new heart failure symptoms or managing a new chronic illness in a homebound elderly patient.
Documentation requirements
To properly support CPT 99345 billing, documentation should include:
- Patient identifiers and date of service
- New patient status
- Reason for home visit and medical necessity
- Time spent face-to-face (approximately 75 minutes)
- Assessment and management activities, including evaluation, counseling, and care coordination
- Clinical findings and any interventions initiated
- Follow-up plans or referrals
Clear documentation supports both reimbursement and high-quality continuity of care.
Reimbursement and coding considerations
CPT 99345 is generally covered by commercial payers, Medicare, and Medicaid when medically necessary. Key considerations:
- Time-based coding should reflect face-to-face interaction
- Home visits are billed separately from office or telehealth visits
- Ensure medical necessity is clearly documented for unstable or significant new problems
- Modifiers may be required for payer-specific policies or multiple visits
Always confirm payer-specific home visit guidelines and coverage.
How OptiMantra supports home visit documentation and billing
OptiMantra’s EMR and practice management platform streamlines home-based care, helping providers accurately track, document, and bill for prolonged, complex visits like CPT 99345.
With OptiMantra, providers can:
- Log total face-to-face time automatically during home visits
- Use home visit E/M templates that capture comprehensive assessments and interventions
- Document clinical findings, care coordination, and patient education efficiently
- Generate audit-ready billing codes aligned with payer requirements
- Integrate home visit documentation into the patient’s longitudinal chart for continuity of care
OptiMantra ensures that home-based services are properly documented and reimbursed, while helping practices deliver high-quality, patient-centered care in any setting.
Try OptiMantra for free here!
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