CPT 99318: Subsequent Nursing Facility Care (Deleted)

Commercial payers pay $181 on average nationally for this procedure.

CPT code 99318 was a deleted code effective Jan. 1, 2023; it previously described subsequent nursing facility care for evaluation and management of residents, typically billed for follow-up visits in a skilled nursing facility or nursing home setting as part of ongoing inpatient-level medical management.

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National Reimbursement Benchmarks

Across national commercial payers, BUCA represents the average commercial benchmark at $181.20 for CPT 99318, positioning the market midpoint for this extended visit code. Blue Cross Blue Shield and Cigna show higher central tendencies than UnitedHealth Group: Cigna’s mean is elevated at $254.20 while Blue Cross Blue Shield’s mean is $164.50 and UnitedHealth Group’s mean is $141.60. Median values likewise place Cigna well above peers, with a median of $242.20 versus $145.30 for Blue Cross Blue Shield and $117.80 for UnitedHealth Group.

Dispersion measured by the interquartile range (P75–P25) highlights differences in rate variability. Blue Cross Blue Shield has a P75–P25 spread of $54.70, UnitedHealth Group is the tightest at $48.60, BUCA’s spread is $70.10, and Cigna is the widest at $123.40. These spreads indicate that Cigna exhibits the greatest variability in commercial rates for this code, while UnitedHealth Group shows the most compression between its mid and upper quartiles.

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CPT 99318: Subsequent Nursing Facility Care (Deleted)

Commercial payers pay $181 on average nationally for this procedure.

Customize your policy alerts

Sign up for cpt 99318 policy alerts

Get alerted when payer policies referencing 99318 are released or updated.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

National Reimbursement Benchmarks

National Payer Mean Reimbursement Rates

Clinical & Coding Specifications

Clinical Context

A typical patient is an older adult residing in a skilled nursing facility who requires subsequent nursing facility care follow-up by a geriatric clinician. The resident is seen for ongoing management of chronic conditions, assessment of functional status, medication reconciliation, and review of new complaints such as memory concerns or progressive debility. The clinician documents time-based face-to-face nursing facility visits addressing changes in cognition, activities of daily living, fall risk, and treatment response. Encounter diagnoses commonly include Z00.00, Z00.01, Z13.89, R41.3, and R54. The clinical workflow includes review of nursing and therapy notes, direct patient assessment at the bedside, focused exam, adjustment of medications or orders, communication with the facility team and family, and documentation of the visit in the resident’s medical record. This deleted code historically accompanied subsequent nursing facility care codes to report extended services or additional visit time and would be replaced now by current applicable subsequent care or prolonged service reporting according to payer guidance.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99307‑99310`	Subsequent nursing facility care codes	These codes represent the standard subsequent nursing facility visit levels with which the deleted code `99318` was historically reported to indicate extended or additional nursing facility care services; they are the primary codes for serial nursing facility visits.

Related Modifiers

8 rows

Modifier	Description	When to Use
22	Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…	- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
23	Modifier -23 (Unusual Anesthesia) is used on anesthesia service CPT codes when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia…	- Use modifier -23 only on anesthesia CPT codes (00100–01999) when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia because of…
52	Modifier ‑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…
53	Modifier 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…
54	Modifier ‑54 (“Surgical care only”) is appended to a CPT surgical procedure when the reporting surgeon performs the intraoperative (surgical) component but does not furnish the preoperative and/or…	- Use modifier -54 when the reporting surgeon provided only the intraoperative (surgical) component of a procedure and preoperative and/or postoperative management has been or will be provided by…
55	Modifier –55 indicates the billing provider furnished only postoperative management for a procedure that has a global surgical period. According to AAPC, this modifier is appended to the same CPT…	- Use modifier -55 when billing the same CPT surgical code that has a 10- or 90-day global period and you, as a provider other than the original surgeon, furnished ONLY postoperative management (no…
56	Modifier ‑56 indicates the reporting provider furnished only the preoperative management for a surgical procedure and did not perform the intraoperative or postoperative care. It is used in…	- Use Modifier -56 when a provider performs only the preoperative management in a split‑care situation (one physician manages preop care while a different physician performs the intraoperative…
62	Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…	- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…

Related Provider Taxonomies

8 rows

Taxonomy Code	Specialty	Notes
207QG0300X	Geriatric Medicine (Family Medicine) Physician	A family medicine physician with special knowledge of the aging process and special skills in the diagnostic, therapeutic, preventive and rehabilitati…
207RG0300X	Geriatric Medicine (Internal Medicine) Physician	An internist who has special knowledge of the aging process and special skills in the diagnostic, therapeutic, preventive and rehabilitative aspects o…
163WG0000X	General Practice Registered Nurse	Nursing Service Providers · Registered Nurse
207R00000X	Internal Medicine Physician	A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults…
293D00000X	Physiological Laboratory	A laboratory that operates independently of a hospital and physician's office to furnish physiological diagnostic services (e.g. EEG's , EKG's, scans,…
207ZB0001X	Blood Banking & Transfusion Medicine Physician	A physician who specializes in blood banking/transfusion medicine is responsible for the maintenance of an adequate blood supply, blood donor and pati…
208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	A thoracic surgeon provides the operative, perioperative and critical care of patients with pathologic conditions within the chest. Included is the su…
1744R1102X	Research Study Specialist	Other Service Providers · Specialist

Frequently Asked Questions

References

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.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.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.

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Clinical & Coding Specifications

Clinical Context

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99307‑99310`	Subsequent nursing facility care codes	These codes represent the standard subsequent nursing facility visit levels with which the deleted code `99318` was historically reported to indicate extended or additional nursing facility care services; they are the primary codes for serial nursing facility visits.

Related Modifiers

8 rows

Modifier	Description	When to Use
22	Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…	- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
23	Modifier -23 (Unusual Anesthesia) is used on anesthesia service CPT codes when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia…	- Use modifier -23 only on anesthesia CPT codes (00100–01999) when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia because of…
52	Modifier ‑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…
53	Modifier 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…
54	Modifier ‑54 (“Surgical care only”) is appended to a CPT surgical procedure when the reporting surgeon performs the intraoperative (surgical) component but does not furnish the preoperative and/or…	- Use modifier -54 when the reporting surgeon provided only the intraoperative (surgical) component of a procedure and preoperative and/or postoperative management has been or will be provided by…
55	Modifier –55 indicates the billing provider furnished only postoperative management for a procedure that has a global surgical period. According to AAPC, this modifier is appended to the same CPT…	- Use modifier -55 when billing the same CPT surgical code that has a 10- or 90-day global period and you, as a provider other than the original surgeon, furnished ONLY postoperative management (no…
56	Modifier ‑56 indicates the reporting provider furnished only the preoperative management for a surgical procedure and did not perform the intraoperative or postoperative care. It is used in…	- Use Modifier -56 when a provider performs only the preoperative management in a split‑care situation (one physician manages preop care while a different physician performs the intraoperative…
62	Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…	- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…

Related Provider Taxonomies

8 rows

Taxonomy Code	Specialty	Notes
207QG0300X	Geriatric Medicine (Family Medicine) Physician	A family medicine physician with special knowledge of the aging process and special skills in the diagnostic, therapeutic, preventive and rehabilitati…
207RG0300X	Geriatric Medicine (Internal Medicine) Physician	An internist who has special knowledge of the aging process and special skills in the diagnostic, therapeutic, preventive and rehabilitative aspects o…
163WG0000X	General Practice Registered Nurse	Nursing Service Providers · Registered Nurse
207R00000X	Internal Medicine Physician	A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults…
293D00000X	Physiological Laboratory	A laboratory that operates independently of a hospital and physician's office to furnish physiological diagnostic services (e.g. EEG's , EKG's, scans,…
207ZB0001X	Blood Banking & Transfusion Medicine Physician	A physician who specializes in blood banking/transfusion medicine is responsible for the maintenance of an adequate blood supply, blood donor and pati…
208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	A thoracic surgeon provides the operative, perioperative and critical care of patients with pathologic conditions within the chest. Included is the su…
1744R1102X	Research Study Specialist	Other Service Providers · Specialist

Frequently Asked Questions

References

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.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.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.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

CPT 99318: Subsequent Nursing Facility Care (Deleted)

Sign up for cpt 99318 policy alerts

National Reimbursement Benchmarks

CPT 99318: Subsequent Nursing Facility Care (Deleted)

Sign up for cpt 99318 policy alerts

National Reimbursement Benchmarks

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

What was CPT 99318 used for before it was deleted?

When did CPT 99318 become deleted?

If 99318 is deleted, how should extended time or additional subsequent nursing facility services be reported now?

Which related CPT codes represent standard subsequent nursing facility visit levels?

What are common diagnoses and clinical situations associated with the visits that 99318 described?

References

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

What was CPT 99318 used for before it was deleted?

When did CPT 99318 become deleted?

If 99318 is deleted, how should extended time or additional subsequent nursing facility services be reported now?

Which related CPT codes represent standard subsequent nursing facility visit levels?

What are common diagnoses and clinical situations associated with the visits that 99318 described?

References