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    OpenPayerBilling CodesSubsequent Nursing Facility CareCPT cpt-99308-subsequent-nursing-facility-evaluation-and-management-low-mdm-20min
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    CPT 99308: Subsequent Nursing Facility Care, Low Complexity

    Medicare pays $81 and commercial payers pay $88 on average nationally for this procedure.

    CPT code 99308 describes a subsequent nursing facility care visit for evaluation and management where the clinician provides a low level of medical decision making and/or documents at least 20 minutes of total face-to-face time on a single date; service type: evaluation and management (E/M) subsequent nursing facility care; typical site of service: nursing facility (skilled nursing facility or long-term care facility).

    For related coverage guidance, see recent payer policy updates: Percutaneous Electrical Nerve Field Stimulation for Functional Abdominal Pain Disorders, Esophagogastroduodenoscopy (EGD) Coverage Policy, Radiofrequency Therapy for Fecal Incontinence.

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    National Reimbursement Benchmarks

    Commercial averages cluster above Medicare for CPT 99308: Blue Cross Blue Shield, Aetna, Cigna, UnitedHealth Group and BUCA all show mean rates higher than Medicare’s $81.2 mean. BUCA’s mean of $87.7 sits modestly above Medicare’s $81.2, while Cigna ($103.3), UnitedHealth Group ($93.7), Blue Cross Blue Shield ($86.0) and Aetna ($71.1) span the commercial spectrum with Cigna at the top among provided means.

    Dispersion measured by interquartile range (P75–P25) is narrowest for Aetna at $21.8 and tight for UnitedHealth Group at $52.4? — correction: computed ranges are Aetna $21.8, Blue Cross Blue Shield $23.3, BUCA $36.3, UnitedHealth Group $52.4, Cigna $64.7. Cigna exhibits the widest IQR at $64.7, indicating greater mid-distribution variability, while Aetna and Blue Cross Blue Shield are the tightest among the listed payers.

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    National Payer Mean Reimbursement Rates

    State Reimbursement Rates

    State: Alaska1 / 51

    Rate by payer

    Clinical & Coding Specifications

    Clinical Context

    An 82-year-old resident of a skilled nursing facility with a history of Type 2 diabetes (E11.9), essential hypertension (I10), difficulty walking (R26.2), prior falls (Z91.81), and recent bed confinement status (Z74.01) is seen for a routine subsequent nursing facility evaluation and management visit. The attending clinician (geriatrician or internal medicine physician) performs a focused history and targeted examination addressing gait instability, blood glucose control, and blood pressure management. The visit includes medication reconciliation, review of recent fall risk interventions, wound inspection if present, and communication with nursing staff and family. Total physician time spent on the encounter on the single date is at least 20 minutes, including face-to-face time, review of records, coordination of care with the facility team, and documentation. The typical workflow: review chart and recent nursing notes, obtain focused interval history from patient and nursing staff, perform targeted exam, adjust medications or order labs as needed, document decision making at a low complexity level, and communicate plan to the facility nursing team and family as appropriate.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure

    Related Modifiers

    8 rows

    ModifierDescriptionWhen to Use
    24Modifier 24 denotes an unrelated evaluation and management (E/M) service performed by the same physician or qualified healthcare professional during a postoperative global period. Per CPT guidance,…- Use modifier 24 when you report an evaluation and management (E/M) service performed by the same physician or same-specialty group during a procedure’s postoperative global period that is unrelated…
    25CPT modifier 25 indicates that on the same day as another procedure or service, the same physician or other qualified health care professional provided a significant, separately identifiable…- When to apply: Use modifier 25 only on an E/M code to indicate the same provider delivered a significant, separately identifiable E/M service on the same day as another procedure or service — i.e.,…
    26Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
    59Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    57CPT® modifier -57 (“Decision for Surgery”) is appended to an Evaluation and Management (E/M) service when that encounter results in the initial decision to perform a major surgery (a procedure with a…- Use modifier 57 when an E/M service provided by the same provider (or same tax ID) on the day of or the day before a major surgical procedure (90‑day global period) results in the initial decision…
    95Modifier 95 indicates that a service was provided via synchronous, real‑time audio‑video telehealth rather than in‑person. Per CMS, AAPC and professional associations, append modifier 95 to claim…- Use modifier 95 to indicate a service was furnished via synchronous, real‑time audiovisual telehealth (a live audio‑video conference between patient and provider) rather than in‑person. - Pair…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207RG0300X
    207Q00000X
    207R00000X
    133VN1401X
    208600000X
    246Q00000X
    2083A0300X
    207ZP0007X

    Related ICD-10-CM Codes

    28 rows

    ICD-10-CM CodeDescription
    B20Human immunodeficiency virus [HIV] disease
    E03.9Hypothyroidism, unspecified
    E11.9Type 2 diabetes mellitus without complications
    E66.9Obesity, unspecified
    E78.5Hyperlipidemia, unspecified
    F03.90Unspecified dementia, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety
    F17.210Nicotine dependence, cigarettes, uncomplicated
    F41.9Anxiety disorder, unspecified
    G30.9Alzheimer's disease, unspecified
    I10Essential (primary) hypertension

    Showing 1–10 of 28

    Related Payer Policy Updates

    Specialty: Gastroenterology1 / 3

    10 rows

    PolicyPayerEffective Date
    Percutaneous Electrical Nerve Field Stimulation for Functional Abdominal Pain Disordersbcbsvermont2026-12-01
    Esophagogastroduodenoscopy (EGD) Coverage Policyevicore2026-11-05
    Radiofrequency Therapy for Fecal IncontinenceCigna2026-10-15
    Magnetic Sphincter Augmentation for the Treatment of Gastroesophageal Reflux Disease (GERD)univerahealthcare2026-10-15
    High-Resolution Anoscopy (HRA)Premera Bluecross2026-10-01
    Gastroesophageal and Gastrointestinal (GI) Services and ProceduresColorado Rocky Mountain Health Plans2026-10-01
    Serum Testing for Hepatic Fibrosis in the Evaluation and Monitoring of Chronic Liver DiseaseOscar Health2026-10-01
    Fecal Analysis in the Diagnosis of Intestinal Dysbiosis and Fecal Microbiota Transplant TestingOscar Health2026-10-01
    Pancreatic Enzyme Testing for Acute PancreatitisOscar Health2026-10-01
    Helicobacter pylori TestingOscar Health2026-10-01

    Related Codes

    CPT-99307-SUBSEQUENT-NURSING-FACILITY-E-M-VISIT-10-MINS

    CPT 99307: Subsequent Nursing Facility Care, Straightforward

    CPT-99309-SUBSEQUENT-NURSING-FACILITY-CARE-MODERATE-COMPLEXITY

    CPT 99309: Subsequent Nursing Facility Care, Moderate Complexity

    CPT-99310-SUBSEQUENT-NURSING-FACILITY-CARE-HIGH-COMPLEXITY-OR-45-MIN-TIME

    CPT 99310: Subsequent Nursing Facility Care, High Complexity

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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    Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

    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
    Lower-time/complexity alternative when the clinician documents only ~10 minutes or straightforward decision making compared with 99308.
    99309Subsequent 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 minutesHigher-time/complexity alternative when documentation supports moderate medical decision making or ~30 minutes total time, compared with 99308.