CPT code 99304: Nursing facility care, initial, straightforward or low complexity2026 Medicare rate & RVUs in Texas
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.
Medicare pays $78.43–$82.55 for 99304 in the office in Texas, from Beaumont, TX to Austin, TX. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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On this page 9 sections
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 in Texas
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
8 payment localities
$78.43 to $82.55
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin, TX | $82.55 | $71.95 |
| Beaumont, TX | $78.43 | $69.31 |
| Brazoria, TX | $80.65 | $70.72 |
| Dallas, TX | $81.08 | $71.10 |
| Fort Worth, TX | $80.83 | $70.95 |
| Galveston, TX | $80.85 | $70.90 |
| Houston, TX | $82.50 | $72.55 |
| Rest of Texas | $79.44 | $69.93 |
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
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.
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.
99304 compared with similar codes
Compare codes · National
4 codes, side by side
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.
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
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