CPT 99350: Home Visit for Established Patient, High Complexity or ≥60 Minutes
Medicare pays $198 and commercial payers pay $229 on average nationally for this procedure.
CPT code 99350 describes an evaluation and management visit for an established patient performed in the patient’s home or residence, delivered either as a high medical decision-making E/M or when the clinician’s total time on the encounter reaches at least 60 minutes on a single date; the service type is a home/residence E/M visit and the typical site of service is the patient’s home or private residence.
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National Reimbursement Benchmarks
Medicare’s mean rate sits at $198.2, closely tracking BUCA’s average commercial mean of $229.0; this positions Medicare modestly lower than the BUCA commercial benchmark but within a comparable band rather than an extreme outlier. The difference between BUCA and Medicare mean rates is $30.8, indicating Medicare reimbursement for CPT 99350 is generally near commercial average levels rather than substantially below.
Dispersion varies notably across payers. Blue Cross Blue Shield has a P75–P25 spread of $81.1, UnitedHealth Group’s spread is $157.3, Cigna’s spread is $164.7, Aetna’s spread is $51.0, and BUCA’s spread is $102.8. Aetna is the tightest payer by this measure, while Cigna shows the widest dispersion, with UnitedHealth Group close behind—highlighting meaningful variation in upper-tail commercial pricing.