CPT code 99305: Nursing facility visit, initial visit, moderate MDM2026 Medicare rate & RVUs

Medicare pays $140.95 for 99305 nationally in the office and $119.91 in a hospital or facility. Local office rates run $130.78–$183.35.

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

What 99305 covers

This initial visit evaluates a resident during a skilled nursing facility (POS 31) or nursing facility (POS 32) stay. The physician or qualified practitioner may review hospital records and transfer orders, reconcile medications, examine the resident, and establish a care plan. Attending physicians, geriatricians, and hospitalists who follow patients into post-acute care commonly perform this service. Nurse practitioners and physician assistants may also provide nursing facility care, subject to Medicare requirements governing the initial comprehensive visit.

Select 99305 using moderate medical decision making (MDM) or at least 35 minutes of the reporting practitioner's total time on the encounter date. Two of the three MDM elements—problems addressed, data reviewed or analyzed, and management risk—must support the level; multiple stable conditions or prescription management alone do not establish moderate MDM. Document the work supporting the selected method. Initial care can be reported for a patient previously seen by the practitioner in another setting. Under Medicare policy, the principal physician of record appends modifier AI to the initial nursing facility care code.

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 99305 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

99305 rates by state

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

How the 99305 rate is calculated

Each of 99305’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 99305

99305 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.

99305 compared with similar codes

How to choose

99309Nursing facility visitSubsequent, moderate MDM or 30 minutes

99309 is a subsequent nursing facility visit with moderate MDM or at least 30 minutes; it may also describe a medically necessary visit before the physician's required initial comprehensive visit. 99305 describes initial care and has a 35-minute time threshold.

99306Nursing facility visitInitial visit, high complexity

99306 requires high MDM or at least 50 minutes; 99305 requires moderate MDM or at least 35 minutes. Select the level supported by the documented MDM or time.

99344Home visitNew patient, moderate complexity

99344 describes a new-patient home or residence visit, such as one in an assisted living facility. 99305 describes initial care in a skilled nursing facility or nursing facility.

99304Nursing facility careInitial, straightforward or low complexity

99304 describes straightforward or low MDM or at least 25 minutes. Choose 99305 when two MDM elements support the moderate level or total practitioner time reaches 35 minutes.

Codes related to 99305

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