Summary & Overview
CPT 99342: Home Visit for New Patient, Low MDM or 30 Minutes
CPT code 99342 identifies a new-patient evaluation and management (E/M) visit performed in the patient’s home or residence involving a low level of medical decision making or at least 30 minutes of total time on a single date. This code captures clinician encounters outside traditional office settings and supports continuity of care for patients who are homebound, have mobility challenges, or require in-home assessment. Nationally, accurate use of this code affects access to home-based primary and specialty care and informs payment for community-based services.
Key payers included in the analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical and billing context for use of 99342, typical settings where it applies, common modifiers associated with home visits, and the items to consider when documenting time and decision making for a new-patient home E/M. The publication summarizes benchmarks and coding relationships where available, highlights policy updates that affect home/residence E/M coding and reimbursement, and provides practical clarity on when 99342 is the appropriate code choice. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 99342 describes an evaluation and management (E/M) visit for a new patient conducted in the patient's home or residence. The service represents a home/residence visit where the clinician performs a focused assessment involving a low level of medical decision making or documents at least 30 minutes of total time spent on the encounter on a single date.
Service type: Home or residence E/M visit for a new patient
Typical site of service: Patient's home or residence
Clinical & Coding Specifications
Clinical Context
A 78-year-old homebound patient with multiple chronic conditions (congestive heart failure, type 2 diabetes, and osteoarthritis) requests an initial home visit after discharge from the hospital. The provider (family medicine physician or nurse practitioner) documents a comprehensive new-patient history, performs a focused physical exam appropriate for the home setting, reviews discharge medications and recent hospital records, and formulates a low level of medical decision making plan. The encounter includes significant face-to-face time coordinating care with family/caregivers and may involve medication reconciliation and arranging community services. Total provider time spent on the date of the visit, including pre-visit review of records, face-to-face care, and post-visit documentation, meets or exceeds 30 minutes, supporting reporting of 99342 for a new patient home/residence E/M visit.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable E/M service on same day as procedure | Use when a distinct E/M is performed and documented on the same day as a separately reportable procedure during the home visit |
26 | Professional component | Use when billing only the professional component is required for a covered ancillary service |
22 | Increased procedural services | Use when the work required is substantially greater than typically required and documentation supports additional work |
52 | Reduced services | Use when the service performed is partially reduced or discontinued |
53 | Discontinued procedure | Use when the visit or planned service is terminated due to extenuating circumstances |
59 | Distinct procedural service | Use to indicate a separate and distinct E/M or procedure when bundling edits would otherwise deny (note: payor-specific) |
95 | Synchronous telemedicine service rendered via real-time interactive audio and video | Use when part of the encounter was delivered via live interactive telehealth and allowed by payor |
24 | Unrelated E/M during a postoperative period | Use if an unrelated problem is addressed during a global surgical period (rare for initial home visit) |
76 | Repeat procedure by same physician | Use if the same service is repeated later the same day for a separately documented reason |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
207Q00000X | Family Medicine | Primary providers performing home-based new patient E/M visits |
207R00000X | Internal Medicine | Hospitalist/primary care internists providing home visits |
363LF0000X | Nurse Practitioner | Common non-physician clinicians performing home/residence E/M visits |
207V00000X | Geriatric Medicine | Specialists frequently providing home-based evaluations for frail elders |
2084P0800X | Palliative Medicine | Providers who perform home initial evaluations for symptom and care planning |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
I50.9 | Heart failure, unspecified | Common chronic condition requiring home-based evaluation and medication reconciliation |
E11.9 | Type 2 diabetes mellitus without complications | Frequent comorbidity addressed during home new-patient visits |
M19.90 | Osteoarthritis, unspecified site | Chronic pain and mobility limitations evaluated in the home setting |
Z74.3 | Need for continuous supervision | Relevant for documenting homebound status and need for home health services |
R53.1 | Weakness | Symptom commonly assessed during an initial home visit |
Z91.19 | Patient's noncompliance with medical treatment and regimen, unspecified | May be identified during medication review and care planning |
F03.90 | Unspecified dementia without behavioral disturbance | Cognitive impairment frequently screened for during home-based evaluations |
Z59.0 | Homelessness | Social determinant sometimes documented in the home/residence context |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
99347 | Established patient home visit, low complexity medical decision making (20 minutes) | Follow-up established-patient home visits after the initial new-patient 99342 visit |
99406 | Smoking and tobacco-use cessation counseling, intermediate, greater than 3 minutes up to 10 minutes | Ancillary counseling service commonly provided during a home visit |
99497 | Advance care planning including explanation and discussion of advance directives (first 30 minutes) | May be performed during a comprehensive new-patient home visit to document goals of care |
99483 | Assessment of and care planning for a patient with cognitive impairment | Often performed subsequent to or as part of the home-based evaluation when cognitive concerns are identified |
99024 | Postoperative follow-up visit, normally included in the surgical package (for reporting purposes in some contexts) | Occasionally relevant if the home visit addresses postoperative care needs following recent hospital discharge |