Description:
CPT® code 99348 is used for a home or residence visit for an established patient that requires a medically appropriate history and/or examination and low to moderate complexity medical decision-making. This code typically reflects encounters lasting around 25 minutes, during which the provider evaluates and manages existing or new health concerns in the patient’s home environment.
When to Use:
Use CPT 99348 when performing an in-person home visit that meets the following criteria:
- The patient is already established with the provider or practice.
- The encounter involves low to moderate severity issues—such as medication management, chronic disease monitoring, or follow-up for a stable condition.
- The provider conducts a medically necessary visit in the patient’s home, residence, or assisted living facility (not a skilled nursing facility).
- The visit duration is approximately 25 minutes, though documentation requirements take precedence over time alone.
Billing Requirements:
- Documentation must include:
- The reason for the visit (e.g., chronic condition follow-up, medication adjustment).
- A problem-focused or expanded history and exam.
- Medical decision-making consistent with low to moderate complexity.
- Total time spent on the date of service, including care coordination or documentation, if billed based on time.
- Report only one home visit code per patient, per day, unless separate, unrelated services are performed.
- Must take place in a home or private residence—not in a facility classified as inpatient or skilled nursing.
Includes:
- Evaluation and management of the patient’s condition in the home setting.
- Counseling, coordination of care, and review of medications or treatment adherence.
- Documentation of the provider’s findings, recommendations, and follow-up plan.
Tips for Practice Efficiency:
Home-based visits often involve complex coordination and detailed documentation. With OptiMantra, providers can:
- Document home visit details quickly using prebuilt templates for established patients.
- Track visit duration and medical decision-making level automatically for accurate coding.
- Streamline billing and claim submission directly from patient records to ensure compliance and timely reimbursement.
By simplifying home care documentation and billing, OptiMantra helps providers deliver personalized, high-quality care wherever patients need it—without administrative delays or coding uncertainty.
Try OptiMantra for free here!
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