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CPT 99318: Subsequent Nursing Facility Care (Deleted)

CPT code 99318 was a subsequent nursing facility care code that was deleted effective Jan. 1, 2023. Its deletion affects clinical documentation and billing for follow-up care provided in skilled nursing and long-term care facilities. Nationally, the removal of this code requires clinicians and billing teams to reference current applicable CPT guidance and remaining subsequent nursing facility codes when documenting and submitting claims for post-acute and long-term facility follow-up services.

This analysis covers payer treatment relevant to the code, with payers in scope including Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the code's status, its historical clinical context for nursing facility follow-up care, how common related codes were used prior to deletion, and references to the set of subsequent nursing facility care codes 99307–99310 that were associated with 99318 in practice. The publication highlights policy updates tied to code deletion, implications for billing workflows, and considerations for medical record documentation when 99318 is encountered in historical records.

Data not available in the input for payer-specific payment benchmarks is noted where applicable. The content is intended for a national audience of clinicians, coding specialists, and revenue cycle professionals seeking clarity on the status and context of CPT code 99318.

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Billing Code Overview

CPT code 99318 is a deleted code, effective Jan. 1, 2023. The code previously described a service related to subsequent nursing facility care and is no longer valid for reporting after the deletion date.

Service type: Subsequent nursing facility care (historical)

Typical site of service: Skilled nursing facility or nursing facility (historical)

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)

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Billing Code Overview

Service type: Subsequent nursing facility care (historical)

Typical site of service: Skilled nursing facility or nursing facility (historical)

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.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when work required is substantially greater than typically required for the visit and documentation supports additional resources.
`23`	Unusual anesthesia	Use if an anesthesia-like circumstance occurred during the encounter per payer rules (rare in nursing facility visits).
`52`	Reduced services	Use when services performed are partially reduced or eliminated at clinician discretion and documented.
`53`	Discontinued procedure	Use when the visit or procedure is started but discontinued due to patient condition or other factors.
`54`	Surgical care only	Not commonly used for nursing facility visits; include when only the surgical component is provided and global period applies.
`55`	Postoperative management only	Use when only postoperative care is provided during the encounter and global surgical package rules apply.
`56`	Preoperative management only	Use when only preoperative care is provided during the encounter.
`62`	Two surgeons	Use when two surgeons are required to perform parts of a procedure; rarely applies to nursing facility visits but included per input list.
`AS`	Ambulatory surgical center (ASC) payment	Use to indicate services furnished in an ASC when applicable to the service location.
`CQ`	Temporary codes for alternative payment models	Use for clinicians participating in certain APMs as defined by payers.
`FX`	Nonparticipating physician rendering service	Use when a nonparticipating physician provides the service and billing rules require indicating nonparticipation.
`FY`	Discontinued outpatient ambulatory surgery procedure	Use when an outpatient ambulatory surgery is discontinued; may apply if a planned procedure in facility is aborted.
`QK`	Medical direction of two, three, or four assistants at surgery	Use when the reporting clinician medically directs multiple assistants at surgery.
`QX`	Certified nurse-midwife or physician assistant service furnished	Use when services are furnished by designated allied health professionals under supervision.
`QY`	Medical professional service by assistant at surgery	Use to indicate assistant-at-surgery services provided by qualified personnel.

Taxonomy Code	Specialty	Notes
`207QG0300X`	Geriatric Medicine Physician	Specialist in comprehensive care of older adults; commonly provides nursing facility follow-up.
`207RG0300X`	Geriatric Medicine (Internal Medicine) Physician	Internal medicine-trained geriatrician who manages complex medical issues in long-term care residents.
`163WG0000X`	Geriatric Nurse Practitioner	Advanced practice clinician providing primary and chronic care management in nursing facilities.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`Z00.00`	Encounter for general adult medical examination without abnormal findings	Used for routine periodic evaluation of an older adult resident when no abnormal findings are documented during the nursing facility follow-up visit.
`Z00.01`	Encounter for general adult medical examination with abnormal findings	Used when the exam during the nursing facility visit identifies abnormal findings requiring follow-up or management changes.
`Z13.89`	Encounter for screening for other disorder	Used when the visit includes screening activities (for example cognitive screening or fall risk assessment) during the nursing facility encounter.
`R41.3`	Other amnesia	Relevant when memory impairment or amnestic symptoms are addressed during the visit and influence management and monitoring.
`R54`	Age-related physical debility	Relevant when the visit focuses on functional decline, frailty, or progressive debility requiring care plan adjustments during the nursing facility follow-up.

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.

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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Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when work required is substantially greater than typically required for the visit and documentation supports additional resources.
`23`	Unusual anesthesia	Use if an anesthesia-like circumstance occurred during the encounter per payer rules (rare in nursing facility visits).
`52`	Reduced services	Use when services performed are partially reduced or eliminated at clinician discretion and documented.
`53`	Discontinued procedure	Use when the visit or procedure is started but discontinued due to patient condition or other factors.
`54`	Surgical care only	Not commonly used for nursing facility visits; include when only the surgical component is provided and global period applies.
`55`	Postoperative management only	Use when only postoperative care is provided during the encounter and global surgical package rules apply.
`56`	Preoperative management only	Use when only preoperative care is provided during the encounter.
`62`	Two surgeons	Use when two surgeons are required to perform parts of a procedure; rarely applies to nursing facility visits but included per input list.
`AS`	Ambulatory surgical center (ASC) payment	Use to indicate services furnished in an ASC when applicable to the service location.
`CQ`	Temporary codes for alternative payment models	Use for clinicians participating in certain APMs as defined by payers.
`FX`	Nonparticipating physician rendering service	Use when a nonparticipating physician provides the service and billing rules require indicating nonparticipation.
`FY`	Discontinued outpatient ambulatory surgery procedure	Use when an outpatient ambulatory surgery is discontinued; may apply if a planned procedure in facility is aborted.
`QK`	Medical direction of two, three, or four assistants at surgery	Use when the reporting clinician medically directs multiple assistants at surgery.
`QX`	Certified nurse-midwife or physician assistant service furnished	Use when services are furnished by designated allied health professionals under supervision.
`QY`	Medical professional service by assistant at surgery	Use to indicate assistant-at-surgery services provided by qualified personnel.

Taxonomy Code	Specialty	Notes
`207QG0300X`	Geriatric Medicine Physician	Specialist in comprehensive care of older adults; commonly provides nursing facility follow-up.
`207RG0300X`	Geriatric Medicine (Internal Medicine) Physician	Internal medicine-trained geriatrician who manages complex medical issues in long-term care residents.
`163WG0000X`	Geriatric Nurse Practitioner	Advanced practice clinician providing primary and chronic care management in nursing facilities.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`Z00.00`	Encounter for general adult medical examination without abnormal findings	Used for routine periodic evaluation of an older adult resident when no abnormal findings are documented during the nursing facility follow-up visit.
`Z00.01`	Encounter for general adult medical examination with abnormal findings	Used when the exam during the nursing facility visit identifies abnormal findings requiring follow-up or management changes.
`Z13.89`	Encounter for screening for other disorder	Used when the visit includes screening activities (for example cognitive screening or fall risk assessment) during the nursing facility encounter.
`R41.3`	Other amnesia	Relevant when memory impairment or amnestic symptoms are addressed during the visit and influence management and monitoring.
`R54`	Age-related physical debility	Relevant when the visit focuses on functional decline, frailty, or progressive debility requiring care plan adjustments during the nursing facility follow-up.

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.

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.