CPT code 99304: Nursing facility care, initial, straightforward or low complexity2026 Medicare rate & RVUs

Medicare pays $81.16 for 99304 nationally in the office and $71.14 in a hospital or facility. Local office rates run $75.75–$106.69.

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

What 99304 covers

Code 99304 describes an initial evaluation and management service for a patient in a nursing facility, such as a skilled nursing facility or nursing home. A physician or other qualified health care professional assesses the patient’s condition and needs in that setting and establishes or updates the care plan. The patient may be new or established to the practitioner; the relevant distinction is that the service is initial nursing facility care, not a later follow-up visit.

Select this level when medical decision making is straightforward or low complexity, or when the practitioner’s total time on the date of service meets or exceeds 25 minutes. Document the medically appropriate history and examination, the problems addressed, the data reviewed or analyzed, and the management decisions; when selecting by time, document the qualifying time. CMS assigns work, practice-expense, and malpractice RVUs, with separate practice-expense values for office and facility settings.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

Where 99304 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

99304 rates by state

Office rate range in each state. Select a state to see its payment localities.

How the 99304 rate is calculated

Each of 99304’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

Payment rules and modifiers for 99304

99304 has no global surgery period, no multiple-procedure, bilateral or assistant-at-surgery adjustment, and no professional/technical split. What changes the payment is where the service happens: the place of service on the claim decides whether Medicare pays the office or the facility rate.

99304 compared with similar codes

How to choose

99305Nursing facility visitInitial visit, moderate MDM

Both describe initial nursing facility care. Choose 99305 when the documented medical decision making is moderate complexity or its applicable time threshold is met; 99304 is for straightforward or low complexity or its threshold.

99306Nursing facility visitInitial visit, high complexity

99306 is the high-complexity initial nursing facility level. Use 99304 when the initial service supports straightforward or low-complexity decision making or meets its time threshold.

99307Nursing facility visitSubsequent visit, straightforward MDM

99307 is for subsequent nursing facility care, not the initial nursing facility service. The sequence of care in the facility distinguishes it from 99304.

Codes related to 99304

Related codes aren’t interchangeable: bill the code that matches the service performed.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Open CMS sourceHow we calculate rates