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

Report this initial nursing facility evaluation when the documented medical decision making is straightforward or low complexity, or the service meets the 25-minute time threshold.

CMS RVU26DEffective Oct 1, 2026One payment locality342.1K Medicare services in 2024

In Nevada, Medicare pays $80.69 for 99304 in the office and $70.66 when it’s performed in a hospital or facility.

$80.69Office (non-facility)
$70.66Hospital or facility
−0.6%vs the national office rate ($81.16)

Check a contract rate as a % of Medicare · 99304 nationwide

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

We’ll open 99304 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Nevada
  2. What 99304 covers
  3. Compared with other areas
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Related codes
  8. Rate history
  9. Where it applies
  10. Billing questions
  11. Sources

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.

How Nevada compares for 99304

Across 109 of 109 payment localities, the office rate for 99304 runs from $75.75 in Arkansas to $106.69 in Alaska. Nevada pays $80.69. The RVUs are the same everywhere; the geographic indexes change the dollars.

99304 in Nevada vs other payment areas
  1. Nevada · this page$80.69
  2. Los Angeles, CA · California$87.34+$6.65
  3. Washington, DC area · District of Columbia$89.20+$8.51
  4. Miami, FL · Florida$86.91+$6.22
  5. Chicago, IL · Illinois$85.55+$4.86
  6. Manhattan, NY · New York$90.68+$9.99
  7. Alaska · Alaska$106.69+$26.00

Other areas in Nevada first, then benchmark localities. Bars start at $0.

Every other payment area

99304 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$76.35$67.58
ArkansasArkansas$75.75$67.14
ArizonaArizona$79.86$70.15
Bakersfield, CACalifornia$83.63$72.65
Chico, CACalifornia$83.31$72.33
El Centro, CACalifornia$83.33$72.35
Fresno, CACalifornia$83.31$72.33
Hanford, CACalifornia$83.31$72.33

99304 rates by state

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

Explore a state

Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

$75.75

$106.69

Color shows the midpoint of each state’s locality range.

View every state and territory as a table
99304 office rate range by state
State / territoryOffice rate rangeLocalities
AK$106.691
AL$76.351
AR$75.751
AZ$79.861
CA$83.31–$97.6829
CO$82.901
CT$84.961
DC$89.201
DE$80.771
FL$81.44–$86.913
GA$78.71–$82.372
GU$83.741
HI$83.741
IA$76.971
ID$77.341
IL$80.42–$85.554
IN$77.571
KS$76.981
KY$77.791
LA$77.81–$79.922
MA$82.84–$88.332
MD$81.76–$89.203
ME$77.78–$79.802
MI$79.11–$82.242
MN$79.861
MO$77.21–$79.823
MS$76.481
MT$81.161
NC$78.201
ND$79.381
NE$77.131
NH$81.941
NJ$86.04–$89.012
NM$79.441
NV$80.691
NY$78.87–$92.255
OH$78.751
OK$77.491
OR$80.16–$84.312
PA$78.70–$83.802
PR$81.431
RI$82.721
SC$78.581
SD$79.171
TN$77.221
TX$78.43–$82.558
UT$79.171
VA$79.80–$89.202
VI$81.431
VT$79.401
WA$82.58–$89.492
WI$77.911
WV$78.781
WY$80.381

See 99304 in every payment locality

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.

How the rate is built · 99304

RVUs × geographic indexes × conversion factor

Office or facility?

Work1.50

1.50 RVUs× 1.000 GPCI

Practice expense0.84

0.84 RVUs× 1.000 GPCI

Malpractice0.09

0.09 RVUs× 1.000 GPCI

Adjusted RVUs

2.4300

Conversion factor

$33.4009

Medicare rate

$81.16

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

The exact Nevada inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

13,045

Code
99304
Physician work
1.50
Practice expense
0.84
Malpractice
0.09

GPCI2026.csv

73

Locality
Nevada
Physician work
1.000
Practice expense
1.001
Malpractice
0.833
Office calculation for 99304 in Nevada
ComponentRVULocality factorAdjusted
Physician work1.50× 1.0001.5000
Practice expense0.84× 1.0010.8408
Malpractice0.09× 0.8330.0750
Total RVUs2.4158
Conversion factor× 33.4009

Office rate, Nevada$80.69

Office: (1.5 × 1 + 0.84 × 1.001 + 0.09 × 0.833) × $33.4009 = $80.69

Facility: (1.5 × 1 + 0.54 × 1.001 + 0.09 × 0.833) × $33.4009 = $70.66

Open 99304 in the RVU calculator

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.

Place of service · 99304

Which rate does Medicare pay?

The POS code on the claim line (CMS-1500 box 24B).

POS 11 · non-facility rate · national

$81.16

Non-facility (office)
$81.16
Facility
$71.14

Higher because the practice carries its own overhead.

How 99304 has changed in Nevada

99304 · Office / nonfacility

$80.69

Effective 2026-10-01

The base rate is $3.66 higher than on 2025-10-01, moving from $77.03 to $80.69 (4.8%).

It is unchanged from the immediately preceding available release, effective 2026-07-01.

Base rate by release · bars start at $0 · select a bar to compare

One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.

What changed, release by release
  1. January 1, 2026

    RVU26A

    $77.03changed to$80.69

    • Conversion factor 32.3465 changed to 33.4009
    • Practice expense RVU 0.78 changed to 0.84
    • Malpractice RVU 0.12 changed to 0.09
    • Practice expense GPCI 1.000 changed to 1.001
    • Malpractice GPCI 0.844 changed to 0.833

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $78.99changed to$77.03

    • Conversion factor 33.2875 changed to 32.3465
    • Malpractice RVU 0.11 changed to 0.12

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $77.70changed to$78.99

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $81.02changed to$77.70

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 0.77 changed to 0.78
    • Malpractice GPCI 1.098 changed to 0.844
  5. January 1, 2023

    RVU23A

    $90.56changed to$81.02

    • Conversion factor 34.6062 changed to 33.8872
    • Work RVU 1.64 changed to 1.50
    • Practice expense RVU 0.82 changed to 0.77
    • Work GPCI 1.005 changed to 1.000
    • Malpractice GPCI 1.351 changed to 1.098

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $91.31changed to$90.56

    • Conversion factor 34.8931 changed to 34.6062

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $92.78changed to$91.31

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 0.80 changed to 0.82
    • Work GPCI 1.004 changed to 1.005
    • Malpractice GPCI 1.130 changed to 1.351

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $91.74changed to$92.78

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 0.78 changed to 0.80
    • Malpractice RVU 0.12 changed to 0.11
    • Work GPCI 1.002 changed to 1.004
    • Practice expense GPCI 1.017 changed to 1.000
    • Malpractice GPCI 0.909 changed to 1.130

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $93.14changed to$91.74

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 0.83 changed to 0.78
    • Malpractice RVU 0.11 changed to 0.12

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $93.63changed to$93.14

    • Conversion factor 35.8887 changed to 35.9996
    • Work GPCI 1.004 changed to 1.002
    • Practice expense GPCI 1.034 changed to 1.017
    • Malpractice GPCI 0.946 changed to 0.909

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $94.11changed to$93.63

    • Conversion factor 35.8043 changed to 35.8887
    • Work GPCI 1.005 changed to 1.004
    • Practice expense GPCI 1.051 changed to 1.034
    • Malpractice GPCI 0.982 changed to 0.946

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $94.45changed to$94.11

    • Conversion factor 35.9335 changed to 35.8043

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $93.98changed to$94.45

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $95.71changed to$93.98

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 0.84 changed to 0.83
    • Malpractice RVU 0.13 changed to 0.11
    • Work GPCI 1.001 changed to 1.005
    • Practice expense GPCI 1.055 changed to 1.051
    • Malpractice GPCI 1.107 changed to 0.982

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $94.42changed to$95.71

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 0.91 changed to 0.84
    • Malpractice RVU 0.14 changed to 0.13
    • Work GPCI 1.000 changed to 1.001
    • Practice expense GPCI 1.058 changed to 1.055
    • Malpractice GPCI 1.232 changed to 1.107

    Held through RVU14B, RVU14C, RVU14D.

  16. October 1, 2013

    RVU13D

    No ratechanged to$94.42

  17. January 1, 2013

    RVU13AR

    Earliest loaded release: No rate

    Held through RVU13B, RVU13C.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$80.69$70.66RVU26D
2026-07-01$80.69$70.66RVU26C
2026-04-01$80.69$70.66RVU26B
2026-01-01$80.69$70.66RVU26A
2025-10-01$77.03$77.03RVU25D
2025-07-01$77.03$77.03RVU25C
2025-04-01$77.03$77.03RVU25B
2025-01-01$77.03$77.03RVU25A
2024-10-01$78.99$78.99RVU24D
2024-07-01$78.99$78.99RVU24C
2024-04-01$78.99$78.99RVU24B
2024-03-09$78.99$78.99RVU24AR
2024-01-01$77.70$77.70RVU24A
2023-10-01$81.02$81.02RVU23D
2023-07-01$81.02$81.02RVU23C
2023-04-01$81.02$81.02RVU23B
2023-01-01$81.02$81.02RVU23A
2022-10-01$90.56$90.56RVU22D
2022-07-01$90.56$90.56RVU22C
2022-04-01$90.56$90.56RVU22B
2022-01-01$90.56$90.56RVU22A
2021-10-01$91.31$91.31RVU21D
2021-07-01$91.31$91.31RVU21C
2021-04-01$91.31$91.31RVU21B
2021-01-01$91.31$91.31RVU21A
2020-10-01$92.78$92.78RVU20D
2020-07-01$92.78$92.78RVU20C
2020-04-01$92.78$92.78RVU20B
2020-01-01$92.78$92.78RVU20A
2019-10-01$91.74$91.74RVU19D
2019-07-01$91.74$91.74RVU19C
2019-04-01$91.74$91.74RVU19B
2019-01-01$91.74$91.74RVU19A
2018-10-01$93.14$93.14RVU18D
2018-07-01$93.14$93.14RVU18C
2018-04-01$93.14$93.14RVU18B
2018-01-01$93.14$93.14RVU18AR1
2017-10-01$93.63$93.63RVU17D
2017-07-01$93.63$93.63RVU17C
2017-04-01$93.63$93.63RVU17B
2017-01-01$93.63$93.63RVU17A
2016-10-01$94.11$94.11RVU16D
2016-07-01$94.11$94.11RVU16C
2016-04-01$94.11$94.11RVU16B
2016-01-01$94.11$94.11RVU16A
2015-10-01$94.45$94.45RVU15D
2015-07-01$94.45$94.45RVU15C
2015-04-01$93.98$93.98RVU15B
2015-01-01$93.98$93.98RVU15A
2014-10-01$95.71$95.71RVU14D
2014-07-01$95.71$95.71RVU14C
2014-04-01$95.71$95.71RVU14B
2014-01-01$95.71$95.71RVU14A
2013-10-01$94.42$94.42RVU13D
2013-07-01Rate data unavailableRate data unavailableRVU13C
2013-04-01Rate data unavailableRate data unavailableRVU13B
2013-01-01Rate data unavailableRate data unavailableRVU13AR

Price 99304 for an earlier date of service

Where the Nevada rate applies

Nevada is a Medicare payment area, not a city. Our Census mapping connects it to 138 cities and communities in Nevada. Some span more than one payment area; confirm with the service ZIP.

  • Alamo
  • Amargosa Valley
  • Austin
  • Baker
  • Battle Mountain
  • Beatty
  • Beaverdam
  • Bennett Springs

Browse all communities in Nevada

99304 billing questions

When should 99304 be chosen over 99305?

Use 99304 for an initial nursing facility service when medical decision making is straightforward or low complexity, or when selecting by time at the 25-minute threshold. Use 99305 when the documented medical decision making is moderate complexity or the applicable time threshold is met.

Does the patient have to be new to the practitioner?

No. The code is for initial nursing facility care and is not determined by whether the patient has previously seen that practitioner.

Can the level be selected by time?

Yes. The practitioner’s total time on the date of service must meet or exceed 25 minutes. Document the qualifying time and the work performed.

How does 99304 differ from a subsequent nursing facility visit?

99304 represents initial nursing facility care. For a later follow-up service in the facility, select the applicable subsequent nursing facility care level, such as 99307 or 99308.

What documentation supports 99304?

Document the clinical issues evaluated, the medically appropriate history and examination, and the reasoning behind the straightforward or low-complexity decisions. If selecting by time, document the total qualifying time on the date of service.

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

Show the CMS file lines behind this rate
RVUs for 99304PPRRVU2026_Oct_nonQPP.csv, line 13,045 (RVU26D)
Geographic factors for NevadaGPCI2026.csv, line 73 (RVU26D)

Open CMS sourceHow we calculate rates

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