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CPT 99308: Subsequent Nursing Facility E/M Visit, Low MDM or ≥20 Minutes
CPT code 99308 designates a subsequent nursing facility evaluation and management (E/M) visit with low medical decision making and/or at least 20 minutes of total provider time on a single date. This code is used when clinicians deliver ongoing, per-day E/M care to nursing facility residents and documents a defined intensity and time commitment. Nationally, accurate use of 99308 affects facility-based billing, continuity of care documentation, and appropriate resource allocation for long-term and skilled nursing populations.
Key payers covered in this summary include Aetna, Blue Cross Blue Shield, Cigna Health, United Healthcare, and Medicare. The publication provides readers with an overview of billing context and clinical scope for 99308, comparisons to adjacent nursing facility codes, common clinical diagnoses encountered, and typical coding considerations relevant to payer adjudication and reporting.
Readers will learn how 99308 fits within subsequent nursing facility E/M services, how it differs from lower- and higher-intensity subsequent care codes, and which clinical scenarios commonly map to this level of care. The content includes benchmarks and policy-relevant highlights for national payer coverage, operational implications for facility workflows, and the clinical contexts in which 99308 is generally applied. Data not available in the input for specific payer reimbursement rates and utilization metrics.
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Billing Code Overview
CPT code 99308 describes a subsequent nursing facility care evaluation and management visit. The service represents a follow-up visit for a patient residing in a nursing facility where the clinician provides an evaluation and management (E/M) encounter that involves a low level of medical decision making and/or at least 20 minutes of total provider time on a single date.
Service type: Subsequent nursing facility E/M visit
Typical site of service: Nursing facility (long-term care or skilled nursing facility)
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.