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CPT 99307: Subsequent Nursing Facility E/M Visit, Straightforward or 10 Minutes
CPT code 99307 identifies a subsequent nursing facility evaluation and management (E/M) visit involving straightforward medical decision making or at least 10 minutes of total provider time on a single date. This code is used nationwide to bill follow-up physician or qualified practitioner care provided to residents of skilled nursing facilities and long-term care settings. It matters nationally because it captures routine, ongoing management of complex post-acute and chronic conditions in institutional settings where continuity and timely follow-up affect outcomes and costs.
Key payers analyzed include Aetna, Blue Cross Blue Shield, Cigna Health, United Healthcare, and Medicare. Readers will find a concise explanation of the clinical context for use of 99307, comparisons to related subsequent nursing facility codes, and the typical sites of service where the code applies. The publication outlines common billing considerations and operational benchmarks relevant to facility-based E/M visits and highlights where 99307 fits within the continuum of nursing facility care codes.
The content is designed for clinicians, revenue cycle staff, and policy analysts seeking a clear national perspective on code definition, appropriate clinical contexts, and how this code interacts with other subsequent nursing facility codes used for follow-up visits. Data not available in the input.
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Billing Code Overview
CPT code 99307 describes a subsequent nursing facility care evaluation and management visit. The service represents a focused follow-up encounter for patients residing in a nursing facility, involving straightforward medical decision making or at least 10 minutes of total provider time spent on the date of the encounter.
Service type: Subsequent nursing facility E/M visit
Typical site of service: Nursing facility (skilled nursing facility or long-term care facility)
National Reimbursement Benchmarks
Medicare’s mean rate of $43.3 sits below BUCA’s average commercial mean of $51.4, indicating that commercial contractual rates for CPT 99307 are generally higher than Medicare by about $8.1 on average. That gap suggests commercial payers are paying at a premium versus the Medicare baseline, with some commercial payers exhibiting substantially higher means (for example, Cigna at $60.7 and UnitedHealth Group at $57.1) while others are closer to Medicare.
Dispersion measured as the interquartile spread (P75 minus P25) varies meaningfully by payer. Blue Cross Blue Shield shows a spread of $16.3, Aetna is $13.0, Cigna is $38.3, UnitedHealth Group is $33.7, and BUCA is $24.3; Medicare’s IQR is narrow at $3.0. Cigna and UnitedHealth Group exhibit the widest IQRs, indicating greater variability in commercial contracting, while Medicare is the tightest.