Summary & Overview
CPT 99347: Home/Residence E/M Visit for Established Patient, ≥20 Minutes
CPT code 99347 represents an evaluation and management (E/M) home or residence visit for an established patient, requiring straightforward medical decision making or at least 20 minutes of total time on a single date. As a nationally used CPT code, it captures physician and qualified health professional services delivered in the patient’s home and is central to billing for in-person home-based primary care, post-discharge follow-up, and geriatric or mobility-limited patient management.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The code’s application affects reimbursement, care access for patients unable to attend office visits, and operational workflows for home visit programs.
Readers will learn the clinical and billing context for CPT code 99347, how it is typically used in home-based E/M encounters, and which payers commonly recognize the service. The publication also outlines benchmarks and policy considerations relevant to E/M home visits, including time-based versus decision-making-based billing guidance and payer-specific coverage trends where available. Data limitations are noted when payer-specific rates or contract details are not provided. The summary is intended for clinicians, billing professionals, and policy analysts seeking a concise national overview of CPT code 99347.
Billing Code Overview
CPT code 99347 describes an evaluation and management (E/M) home or residence visit for an established patient. The service covers encounters in which the visit involves straightforward medical decision making or the provider spends at least 20 minutes of total time on the single-date encounter.
Service type: E/M home or residence visit for established patients
Typical site of service: Patient's home or residential setting
Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes.
Clinical & Coding Specifications
Clinical Context
An established adult patient receives a billed home visit for evaluation and management by a qualified provider. The visit occurs at the patient’s private residence or assisted-living facility because the patient has limited mobility or significant functional impairment. The provider documents a focused history, an interval assessment of chronic conditions (for example congestive heart failure, chronic obstructive pulmonary disease, diabetes mellitus), medication review, brief focused examination, and formulation of a treatment plan. The encounter involves straightforward medical decision making or the provider documents at least 20 minutes of total time spent on the date of service including travel, chart review, patient interaction, and care coordination. Typical workflow includes pre-visit chart review, travel to the residence, in-person evaluation and counseling, possible minor procedures or medication administration permitted in the home setting, coordination with visiting nurses or family caregivers, and documentation of time or MDM to support 99347. Common payors for home visits include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare; coverage policies and documentation requirements vary by payor and by whether the patient is enrolled in home health services or Medicare homebound criteria are met.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable evaluation and management service by the same physician on the same day of a procedure |