Summary & Overview
CPT 99308: Subsequent Nursing Facility Care, Low Complexity
CPT code 99308 is a nationally recognized billing code for subsequent nursing facility care, specifically for evaluation and management services that require a medically appropriate history and/or examination and a low level of medical decision making. This code is commonly used by physicians in geriatric, family, and internal medicine to document and bill for ongoing patient care in skilled nursing facilities and other nursing facility settings. The code is selected when the provider spends at least 15 minutes with the patient on the date of the encounter.
Major payers covering this code include Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare. Understanding the use and requirements of CPT 99308 is essential for compliance and accurate billing in post-acute care settings. This publication provides an overview of the clinical context, payer coverage, and relevant policy updates for this code. Readers will gain insight into benchmarks for utilization, documentation standards, and the role of CPT 99308 in the continuum of nursing facility care. The summary also highlights related codes for varying levels of complexity and time, as well as common modifiers and associated clinical diagnoses. This information is valuable for healthcare administrators, billing professionals, and clinicians seeking to stay informed about evolving standards in nursing facility evaluation and management services.
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 & Coding Specifications
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
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Modifiers:
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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.
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Provider Taxonomies:
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