Overview
CPT® Code 99350 is used to report a home visit for an established patient who presents with an unstable or significant new problem requiring extended evaluation and management. This code applies to complex visits where the patient cannot easily travel to a clinic and the provider must assess, diagnose, and manage acute or exacerbated conditions in the home setting.
CPT 99350 represents the evaluation and management (E/M) service performed in the home. Any additional procedures or tests are billed separately.
Key Facts About CPT® 99350
- Service type: Home E/M visit
- Provider type: Physicians, nurse practitioners, and physician assistants
- Medical services included:
- Comprehensive history and physical examination
- Evaluation of unstable or significant new problems
- Medical decision-making appropriate to the patient’s condition
- Time-based: Typically 40–74 minutes for a single home visit
- Common clinical indications:
- Acute exacerbation of chronic illnesses (e.g., COPD, CHF, diabetes)
- New-onset medical problems in homebound patients
- Complex medication management or adjustments
- Monitoring high-risk patients with limited mobility
- Coordinating care in home or community settings
When to Use CPT® 99350
CPT 99350 is appropriate when:
- The patient is homebound or unable to attend a clinic
- There is a significant new problem or an unstable chronic condition
- Extended evaluation and management are medically necessary
- The visit is for an established patient, not a new patient
Examples:
- Home evaluation of a patient with sudden shortness of breath and edema
- Management of uncontrolled diabetes with new complications in a homebound patient
- Assessment and treatment planning for acute infection in a frail elderly patient
- Medication reconciliation and adjustment for a recently discharged patient with heart failure
Documentation Requirements
To properly support CPT 99350 billing, documentation should include:
- Patient identifiers, date, and location of service
- Comprehensive history and physical exam
- Description of the new or unstable problem(s)
- Medical decision-making rationale and interventions
- Time spent and clinical complexity
- Follow-up plan, referrals, or home care recommendations
Thorough documentation ensures reimbursement compliance, audit readiness, and continuity of care.
Reimbursement and Coding Considerations
- CPT 99350 is reimbursed by Medicare, Medicaid, and commercial payers when medically necessary
- Home visits require documentation that the patient is homebound or has significant limitations
- New or complex problems justify the higher-level home visit code
- Additional services (labs, procedures, medications) are billed separately
- Verify payer-specific rules for home health E/M services
How OptiMantra Supports Home Visit Management
OptiMantra’s integrated EMR and practice management system streamlines documentation, scheduling, and billing for home visits like CPT 99350.
With OptiMantra, providers can:
- Document home visit histories, physical exams, and clinical findings using structured templates
- Track patient homebound status, visit times, and complexity levels
- Generate clean, audit-ready E/M claims for complex home care visits
- Integrate home visit outcomes into broader care plans and longitudinal records
- Coordinate care and follow-up across multidisciplinary teams
By centralizing documentation, billing, and patient care tracking, OptiMantra ensures efficient, compliant, and patient-centered home healthcare.
Try OptiMantra for free here!
.png)
