CPT Code Overview

CPT 99308 is used for subsequent nursing facility care, per day, for the evaluation and management of a patient. This code applies when a medically appropriate history and/or examination is performed and a low level of medical decision making is required. When selecting this code based on total time spent on the date of the encounter, at least 15 minutes must be met or exceeded.

Service Type: Evaluation and Management – Nursing Facility Services

Typical Site of Service: Nursing Facility, including skilled nursing facilities (SNF) or nursing facility per diem.

Clinical Context

A typical patient scenario involves an elderly individual residing in a skilled nursing facility who requires ongoing evaluation and management for chronic medical conditions. The provider, such as a geriatric medicine physician, family medicine physician, or internal medicine physician, conducts a medically appropriate history and/or examination and makes low-level medical decisions. The encounter lasts at least 15 minutes and may address issues such as bed confinement, history of falls, difficulty walking, hypertension, or diabetes. The workflow includes reviewing the patient's status, updating care plans, and documenting the visit for subsequent nursing facility care.

Coding Specifications

• Modifiers:

  • Modifier 25: Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service. Used when an E/M service is distinct from other procedures performed on the same day.

  • Modifier 59: Distinct Procedural Service. Used to indicate that a procedure or service is separate and distinct from other services performed on the same day.

• Provider Taxonomies:

These taxonomies represent the specialties commonly providing subsequent nursing facility care services.

Related Diagnoses

• Z74.01 – Bed confinement status

  • Indicates the patient is confined to bed, relevant for ongoing nursing facility care and evaluation of mobility and risk factors.

• Z91.81 – History of falling

  • Documents a history of falls, important for assessing fall risk and implementing preventive measures during nursing facility care.

• R26.2 – Difficulty in walking, not elsewhere classified

  • Reflects mobility challenges, which are commonly addressed in nursing facility management and care planning.

• I10 – Essential (primary) hypertension

  • Represents chronic hypertension, a frequent condition managed during subsequent nursing facility visits.

• E11.9 – Type 2 diabetes mellitus without complications

  • Indicates diabetes without complications, often requiring ongoing monitoring and management in nursing facility settings.

Related CPT Codes

• 99307: Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward medical decision making; typically 10 minutes.

  • This code is used for encounters requiring less time and lower complexity than 99308. It is an alternative for patients with less intensive needs.

• 99309: Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making; typically 30 minutes.

  • This code is used for encounters requiring more time and higher complexity than 99308. It is an alternative for patients with more intensive needs.

These codes are commonly used as alternatives to 99308 depending on the complexity and time spent during the encounter.

For CPT code 99308, the national mean rate for Medicare is $81.17, while the average commercial benchmark (BUCA) is $84.24. Commercial payers such as Cigna and UnitedHealth Group offer higher mean rates, with Cigna at $99.40 and UnitedHealth Group at $93.79, compared to both Medicare and BUCA.

Rate dispersion varies significantly across payers. Medicare shows the tightest range, with a difference of only $6.00 between the 75th and 25th percentiles, indicating consistent reimbursement. In contrast, Cigna has the widest spread at $55.33, followed by UnitedHealth Group at $50.00 and Blue Cross Blue Shield at $37.40, reflecting greater variability in commercial rates.

The table and chart below present a detailed breakdown of national mean rates and percentile values for each payer.