CPT 99341–99350 Guide (2026)

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KEY TAKEAWAYS AT A GLANCE

✓         CPT 99341–99345 = new patient home/residence visits; 99347–99350 = established patients

✓         Code 99343 was permanently deleted in 2023 — there is a gap in the new patient series

✓         MDM or total provider time on date of service drives code selection — NOT history/exam

✓         Place of Service (POS) code 12 (Home) is required for private residences; additional POS codes now accepted for assisted living and similar settings

✓         G2211 complexity add-on is NOW billable with CPT 99341–99350 effective January 1, 2026

✓         Homebound status is NOT required to bill 99341–99350 — but medical necessity must be documented

✓         Prolonged services: use 99417 for commercial payers; G0318 for Medicare patients

The Home Visit Billing Problem That Is Costing Practices Real Money

A geriatric physician drives 20 minutes to see an 84-year-old patient with advanced heart failure, moderate dementia, and poorly controlled diabetes. She spends 55 minutes at the residence, reviews labs from the cardiologist, adjusts three medications, counsels the patient's adult daughter on fall prevention, and coordinates with a home health agency. She returns to the office and the visit is logged as a 99348 the same code used for a 30-minute, low-complexity established patient visit.

That is not a documentation error. That is a billing system that was never properly configured for the complexity of home-based geriatric care. The physician performed a visit that clearly supports a 99349 or 99350 but without a workflow that captures MDM complexity at the point of care, the revenue walks out the door every single visit.

Home and residence visits are among the most undervalued and most incorrectly coded E/M services in geriatrics. The CPT 99341–99350 code family now governs not just traditional house calls but also visits to assisted living facilities, group homes, custodial care settings, and any residence where minimal healthcare is provided. With the 2026 CMS Physician Fee Schedule finalizing G2211 add-on eligibility for this entire code family, the revenue potential of correctly billing home visits has never been higher — and the cost of getting it wrong has never been more avoidable.

8 Active CPT codes in the 99341–99350 family (99343 deleted)

2026 Year G2211 complexity add-on became billable with home visit codes

POS 12 Required place-of-service for private home visits

NO Homebound status NOT required for 99341–99350

What Is CPT 99341–99350? Full Code Family Explained

The CPT 99341–99350 series covers Evaluation and Management services provided in a home or residence setting. Since the 2023 E/M restructuring which merged the old domiciliary, rest home, and custodial care codes (99324–99340) into this unified family these codes now apply broadly across any place where a patient lives but where significant medical or psychiatric care is NOT routinely provided.

That means private homes, apartments, assisted living facilities, group homes, temporary lodging, and similar settings all fall under this code family. Nursing facilities, skilled nursing facilities, and psychiatric residential facilities use different code sets (99304–99316).

Code selection is based on either Medical Decision Making (MDM) complexity OR total provider time on the date of service. History and physical examination are still expected to be documented when performed but they do not drive the level of service selection.

Complete CPT 99341–99350 Code Reference Table

2026 CRITICAL UPDATE — G2211 Now Billable With Home Visit Codes

Effective January 1, 2026, CMS finalized the expansion of the G2211 visit complexity add-on code to the entire CPT 99341–99350 home and residence E/M family. G2211 recognizes the inherent complexity of longitudinal, patient-centered care relationships — exactly the kind of care delivered in home-based geriatric practice. When a provider serves as the ongoing focal point for a patient's care, or manages a single serious or complex condition across visits, G2211 can be billed in addition to the base home visit code. This is a significant revenue opportunity that most geriatrics practices are not yet capturing.

G2211 Medicare reimbursement: approximately $16–$18 per qualifying visit. For a practice conducting 60 home visits per month, this represents $11,000–$13,000 in additional annual revenue from a single add-on code — with no additional clinical work required beyond the documentation that supports medical necessity.

When Home Visit Codes Apply: Settings and Patient Eligibility

One of the most persistent misconceptions about CPT 99341–99350 is that patients must be "homebound" under Medicare's home health benefit to qualify. That is incorrect. The homebound requirement applies to Medicare home health services (skilled nursing, PT, OT). For physician E/M visits billed under the 99341–99350 code family, no homebound certification is required but the medical record must document why the visit occurred in the home rather than the office.

Qualifying Settings for CPT 99341–99350

•         Private residence or apartment — the patient's primary home

•         Temporary lodging — hotel, short-term rental, family member's home during recovery

•         Assisted living facility — now explicitly included post-2023 code restructure

•         Group home or board-and-care facility — settings where basic supervision but not medical care is provided

•         Independent living community — where no significant healthcare infrastructure exists

Settings Where These Codes Do NOT Apply

•         Skilled nursing facilities (SNF) — use CPT 99307–99310

•         Nursing facilities with significant medical care — use CPT 99304–99310

•         Psychiatric residential treatment facilities — use facility-specific codes

•         Intermediate care facilities for intellectual disabilities — use facility codes

DOCUMENTATION REQUIREMENT — Medical Necessity for Home Visit

The OIG and Medicare Administrative Contractors regularly audit home visit claims. Every claim must include a documented clinical reason why the service was provided in the patient's residence rather than the office. Acceptable rationale includes: severe mobility limitations, cognitive impairment making transport unsafe, high fall risk, post-discharge monitoring in the home environment, caregiver burden assessment requiring in-home observation, or home environment evaluation for safety and infection risk. 'Patient prefers home visits' alone is not sufficient.

Documentation Requirements: Building a Claim That Survives Audit

Home visit documentation has unique requirements that differ from office-based E/M notes in important ways. The home environment itself is part of the clinical picture and that context must be reflected in the record. Here is the complete documentation framework for a defensible CPT 99341–99350 claim:

DOCUMENTATION CHECKLIST — CPT 99341–99350 Home & Residence Visits

SECTION 1 — MEDICAL NECESSITY & SETTING

✓         Explicit statement of why the visit occurred at the patient's residence (mobility limitation, cognitive status, safety concern, etc.)

✓         Place of service documented and consistent with claim (POS 12 for private home; verify correct POS for ALF)

✓         Date of service, provider name, NPI, and patient identifying information

✓         Whether patient is new or established (drives which code family: 99341–99345 vs 99347–99350)

SECTION 2 — MEDICALLY APPROPRIATE HISTORY

✓         Chief complaint or reason for today's home visit

✓         Updated problem list — all active conditions reviewed and status noted (stable, worsening, improving)

✓         Medication review — all current medications listed; changes and rationale documented

✓         Review of systems relevant to conditions addressed at the visit

✓         Social and family history updated as relevant to today's clinical decisions

SECTION 3 — HOME ENVIRONMENT ASSESSMENT

✓         Observations about the patient's living environment (safety hazards, cleanliness, fall risks, accessibility)

✓         Caregiver presence and capability documented — caregiver stress, knowledge, and availability

✓         Medication storage and compliance assessment — are medications organized, accessible, and being taken correctly

✓         Food security, hydration status, and nutritional environment noted

✓         Equipment assessment — oxygen, DME, wound care supplies present and functioning

SECTION 4 — PHYSICAL EXAMINATION

✓         Age-appropriate examination documented with specific findings (not just 'exam performed')

✓         Vital signs — BP, pulse, respiratory rate, weight, O2 saturation where indicated

✓         Focused examination of systems relevant to conditions addressed

✓         Functional status assessment — ambulation, ADL independence, fall risk

✓         Cognitive assessment when relevant — documented score or clinical observation

SECTION 5 — MEDICAL DECISION MAKING (MDM)

✓         Problems addressed — explicitly listed with stability status and complexity level

✓         Data reviewed — what labs, imaging, or external records were reviewed, and your clinical interpretation

✓         External consultations or specialist communications — documented with date and content

✓         Risk level of management decisions — explicitly documented (e.g., initiating anticoagulation, adjusting insulin)

✓         If time-based: total provider time stated explicitly (e.g., '48 minutes total on date of service including travel documentation, exam, care coordination calls')

SECTION 6 — CARE COORDINATION & PLAN

✓         All medication changes documented with specific dose, frequency, and rationale

✓         Lab or diagnostic orders placed — documented with clinical reason

✓         Referrals to specialists or home health services documented

✓         Communication with home health agency, hospice, or other care team members noted

✓         Patient and caregiver education provided — topics and response documented

✓         Follow-up plan — timeframe and trigger conditions specified

✓         G2211 justification documented if add-on code billed — note longitudinal relationship and focal point of care

Home Visit Billing Workflow: Step by Step

The workflow that protects home visit revenue starts before the provider leaves the office and ends with a post-submission denial review. Each step addresses a specific failure point we see in geriatrics home visit billing:

STEP 01  —  Confirm Patient Status and Setting Before the Visit

Is this a new patient or established? New patients who have not been seen by any provider of the same specialty in your group within the past three years use CPT 99341–99345. Established patients use 99347–99350. Confirm the setting: private home (POS 12), assisted living (POS 12 or 13 depending on the facility's license level), or another qualifying setting. If the setting is a skilled nursing facility or nursing home with significant medical services, stop — these require different CPT codes (99304–99310).

STEP 02  —  Document Medical Necessity for the Home Setting

Before the visit occurs, ensure the medical record contains or will contain a specific, documented reason why this service is being provided at the patient's residence. 'Severe mobility limitations secondary to bilateral knee OA and CHF making safe transport to office clinically risky' is defensible. 'Patient prefers home visits' is not. This is the single most common Medicare audit trigger for home visit claims.

STEP 03  —  Provider Documents MDM or Time at Point of Care

At the visit, the provider must clearly document either: (a) the MDM elements problems addressed with complexity, data reviewed with interpretation, and risk of management decisions, OR (b) total time on the date of service stated explicitly in minutes, including pre-visit chart review, the face-to-face encounter, post-visit documentation, and same-date care coordination calls. The documentation must make the selection method obvious.

STEP 04  —  Select the Correct CPT Code Based on Documented Evidence

Match the documented MDM level or time to the appropriate code: 99341 (straightforward/15 min new) through 99345 (high/75 min new) for new patients; 99347 (straightforward/20 min est) through 99350 (high/60 min est) for established patients. Do not code based on gut feeling or habit — code to what the documentation supports. If the documentation supports 99349 but the practice always bills 99348, that is systematic undercoding.

STEP 05  —  Assess G2211 Eligibility and Add-On Code Opportunities

As of January 1, 2026, G2211 can be billed with any CPT 99341–99350 code when the provider serves as the continuing focal point for the patient's care or manages a single serious/complex condition longitudinally. For established geriatric patients seen regularly at home, G2211 is almost always appropriate — but the documentation must note the longitudinal care relationship. Also assess whether prolonged services apply: use 99417 (commercial) or G0318 (Medicare) when time exceeds the highest level threshold by 15+ minutes.

STEP 06  —  Assign Correct Place of Service Code

Place of Service 12 (Home) is the standard code for private residences. Assisted living facilities also use POS 12 in most CMS contexts. Confirm your Medicare Administrative Contractor (MAC) guidance — some MACs have updated their POS guidance following the 2023 code restructure that merged domiciliary codes into the home visit family. An incorrect POS code generates an automatic denial that cannot be appealed as a coverage issue.

STEP 07  —  Pre-Submission Claim Review and Denial Prevention

Before the claim submits: verify CPT code matches patient status (new vs established), confirm POS code is correct, confirm diagnosis codes support medical necessity, verify G2211 documentation if billed, and check for any same-day services that require modifier application. A 90-second pre-submission review eliminates the majority of home visit denials.

Common Denial Reasons — With Root Causes and Fixes

Medicare and Commercial Insurance: Coverage Rules in 2026

Home visit coverage varies more between payer categories than nearly any other E/M service type. Here is what providers need to know about each payer segment:

Payer Type	Coverage Status	Key 2026 Updates	Critical Requirements
Original Medicare (Part B)	Covers 99341–99350 with documented medical necessity	G2211 add-on NOW eligible (Jan 2026); G0318 for prolonged services	Medical necessity documented; correct POS code; provider must be enrolled in Medicare
Medicare Advantage	Most plans cover; terms vary significantly by plan	Some MA plans have stricter prior authorization requirements than Original Medicare	Always verify MA plan-specific home visit coverage and prior auth requirements before the visit
Commercial PPO/EPO	Generally covered; frequency and documentation rules vary	UHC, Aetna, BCBS all accept MDM- or time-based selection per 2023 E/M restructure	Check payer-specific policies for home visit frequency limits and prior auth thresholds
Medicaid	State-dependent; most cover home visits for qualifying patients	Some states require prior authorization or limit visits per year	Verify state-specific Medicaid home visit coverage, visit limits, and credentialing requirements
Self-Pay	Full cost to patient; post No Surprises Act, GFE required	Good Faith Estimate required for uninsured/self-pay patients before service	Provide cost estimate in advance; document patient acknowledgment of charges

PRO TIP — Prior Authorization for Home Visits

Medicare does not require prior authorization for physician home visit E/M services under the 99341–99350 code family. However, some Medicare Advantage plans do — and this varies by plan, by patient, and even by diagnosis. The easiest way to find out: call the MA plan's provider line before the first home visit and ask specifically whether home-based physician E/M visits require prior authorization for this patient's plan. A two-minute call prevents a 45-day denial appeal.

2026 Reimbursement Insights for Home Visit E/M Codes

Home visit codes are classified as non-facility services by CMS even when provided at an assisted living facility or similar setting. This means they receive non-facility Practice Expense (PE) RVUs, which are higher than facility PE RVUs. In practical terms, the physician's work is valued more per visit in a home or residence setting than the same complexity of work done in a hospital or SNF.

CPT Code	Medicare Est. Rate*	Commercial Range	Non-Facility PE	2026 Revenue Note
99341	~$75–$85	$80–$120	Higher than facility	Low use in complex geriatrics; mostly stable single-condition follow-ups
99342	~$110–$125	$120–$170	Higher than facility	Low MDM new patient; more common in initial medication management visits
99344	~$175–$200	$190–$260	Higher than facility	The most underutilized new patient code; moderate complexity is common in geriatrics
99345	~$225–$260	$250–$330	Higher than facility	Reserve for genuinely high-risk visits with documented high MDM
99347	~$65–$80	$70–$110	Higher than facility	Most common undercoded established visit; stable single condition
99348	~$100–$115	$110–$155	Higher than facility	Often used where 99349 is clinically appropriate — systematic undercoding risk
99349	~$150–$175	$165–$230	Higher than facility	The correct level for most complex established geriatric home visits
99350	~$195–$230	$215–$300	Higher than facility	High MDM visits; unstable multimorbidity, hospitalization decisions
+ G2211	~$16–$18 (Medicare)	Varies by payer	Add-on only	New Jan 2026: billable with 99341–99350. Significant longitudinal revenue opportunity.

*Medicare rates are national non-facility averages based on the 2026 Physician Fee Schedule. Geographic adjustments via GPCI will affect actual payment. Always verify current rates through the CMS PFS Look-up Tool.

Real-World Billing Challenges in Home-Based Geriatric Care

Physicians Under-Documenting at the Point of Care

•         The home environment is distracting and note-taking is harder. Providers often complete a comprehensive, complex visit but document a abbreviated note that only supports a lower code level

•         Without a structured template, MDM elements especially data review interpretation and risk justification go undocumented even when the clinical work clearly occurred

•         Time is frequently not documented explicitly. 'Spent significant time with patient' does not support a time-based code. '52 minutes total on date of service' does.

Nurses and Clinical Staff Missing Coordination Documentation

•         Care coordination calls with home health agencies, hospice, specialist offices, and social services count toward time-based E/M coding but only if documented in the record on the same date of service

•         Staff who schedule follow-up referrals, call the pharmacy, or contact the home health agency on the day of the visit are generating billable time that is routinely left out of notes

•         Caregiver conversations that inform the clinical decision-making should be documented — they contribute to data complexity under MDM

Coding Staff Misinterpreting MDM Complexity

•         The most systematic error: treating every established home visit as a 99348 because it 'seems like a moderate visit.' MDM complexity must be assessed against the specific AMA criteria — number and complexity of problems, data reviewed, and risk of management decisions

•         Polypharmacy management is almost always moderate complexity MDM prescription drug management decisions, especially involving high-risk medications, meet the risk element of 99349

•         Reviewing and interpreting a specialist's test results counts as a data element for MDM — but only if the note explicitly documents that the provider reviewed the result and states what clinical conclusion was drawn

COMMON MISTAKE ALERT — The Undercoding Habit

The most expensive billing habit in home-based geriatric medicine: defaulting to 99347 or 99348 for every established patient visit regardless of actual complexity. We consistently see practices where 70–80% of established home visit claims are billed at the two lowest levels — but when those visits are audited against the clinical documentation, the majority support 99349 or 99350. That gap costs a high-volume home visit practice $40,000–$80,000 annually in legitimate revenue that was earned and never collected.

How MedCloudMD Optimizes Home Visit Billing for Geriatrics Practices

Home-based geriatric billing is a specialty within a specialty. It requires expertise in MDM complexity assessment, place-of-service rules, Medicare home visit policy, G2211 add-on eligibility, prolonged service coding, and denial management specific to the 99341–99350 code family. That is what MedCloudMD's geriatrics billing team does every day.

Frequently Asked Questions

Q1: Does a patient have to be homebound to be billed under CPT 99341–99350?

No. The homebound requirement applies to Medicare's home health benefit — skilled nursing visits, physical therapy, occupational therapy billed under the home health agency benefit. For physician E/M visits billed under CPT 99341–99350, there is no homebound requirement. However, your clinical documentation must include a specific medical reason why the visit occurred at the patient's residence rather than your office. A patient with severe COPD, advanced dementia, or who is bedbound has an obvious medical reason. A patient who is fully ambulatory and drives needs a more explicitly documented clinical justification.

Q2: What happened to CPT 99343?

CPT 99343 was permanently deleted when the AMA restructured the home and domiciliary visit codes effective January 1, 2023. There is now a gap in the new patient series: 99341 (straightforward), 99342 (low), then 99344 (moderate) skipping 99343 entirely. If your billing system or superbill still shows 99343, remove it immediately. Any claim submitted with this code will be rejected at adjudication as an invalid code.

Q3: Can I bill both a home visit code and G2211 in the same claim?

Yes — effective January 1, 2026, G2211 is billable alongside any CPT 99341–99350 code when the documentation supports it. G2211 requires that the provider serves as the continuing focal point for all of the patient's healthcare needs, or manages a single serious or complex condition longitudinally. For most established patients seen by a geriatric physician on a regular basis at home, G2211 is clinically appropriate — but the note must explicitly reflect the longitudinal care relationship.

Q4: What is the correct Place of Service code for an assisted living facility visit?

Following the 2023 code restructure that merged domiciliary and home visit codes, assisted living facilities that do not provide significant medical or psychiatric care are generally billed with POS 12 (Home). However, CMS has clarified that the specific POS code depends on the facility's licensure and the services provided there. Always verify your Medicare Administrative Contractor's current guidance for the specific type of assisted living facility you are visiting MAC interpretation has varied since the code merger.

Q5: When can I bill prolonged services with a home visit code?

For commercial payers: when total time on the date of service exceeds the highest-level threshold (99345 or 99350) by at least 15 minutes, you can add CPT 99417 for each additional 15-minute increment. For Medicare patients: use G0318 instead of 99417, and the time thresholds are higher total time must reach 140 minutes with 99345 (new patient) or 110 minutes with 99350 (established patient). G0318 also allows time from the three days before and seven days after the visit to count, unlike the same-date-only rule for standard home visit time-based coding.

Q6: Can a nurse practitioner or PA bill home visit codes?

Yes. Nurse Practitioners and Physician Assistants can bill CPT 99341–99350 under their own NPI when they independently provide the service, reimbursed at 85% of the Medicare Physician Fee Schedule rate. If the service qualifies as incident-to (under direct supervision of the supervising physician in an established patient's plan of care), it can be billed at 100% under the physician's NPI. However, incident-to billing in a home setting is complex the physician's direct supervision requirement is difficult to meet when the supervising provider is not physically present. Verify your MAC's specific incident-to requirements for home-based services before billing under this structure.

Home Visit Revenue Is Being Left Behind. MedCloudMD Helps You Capture It.

Every undercoded 99348 that should have been a 99349. Every claim denied for a missing POS code. Every G2211 add-on that was never billed. This is revenue your providers earned providing complex geriatric care at home — and it belongs to your practice.

What a Free Home Visit Billing Audit Includes:

✔  MDM complexity review: comparing your documented visits to billed code levels

✔  G2211 eligibility assessment across your current home visit claim volume

✔  Place-of-service compliance check for every home and ALF visit

✔  Denial root cause analysis with specific corrective actions

✔  AAPC-certified geriatrics coders. Starting at 2.95%. No startup fees. Cancel anytime.

Get Your Free Home Visit Billing Audit: medcloudmd.com/specialties/geriatrics-billing-services

About MedCloudMD: MedCloudMD is a U.S.-based medical billing and revenue cycle management company with specialized expertise in geriatrics billing, home visit coding, and Medicare compliance. Our AAPC-certified coding team helps geriatric physicians, home-based care practices, and geriatric clinics across the country reduce denials, capture underbilled revenue, and stay current with CMS guidelines. This article reflects 2026 CPT and CMS guidance current as of publication. Always verify current payer policies and MAC guidance for specific billing decisions.

Sources: AMA CPT Code Set 2026 | CMS CY 2026 Physician Fee Schedule Final Rule (CMS-1832-F) | CMS MLN E/M Services Guide (May 2026, MLN006764) | CMS Medicare Claims Processing Manual Ch. 12 | AAPC Home Visit Coding Resources | AAFP FPM Blog: Coding for Home Visits | HCCI Home Visits E/M Guide 2025