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

Report an initial nursing facility visit supported by moderate medical decision making or at least 35 minutes of practitioner time on the encounter date.

CMS RVU26DEffective Oct 1, 2026One payment locality1.1M Medicare services in 2024

In Queens, NY, Medicare pays $158.31 for 99305 in the office and $133.44 when it’s performed in a hospital or facility.

$158.31Office (non-facility)
$133.44Hospital or facility
+12.3%vs the national office rate ($140.95)

Check a contract rate as a % of Medicare · 99305 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 99305 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Queens, NY
  2. What 99305 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 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.

How Queens, NY compares for 99305

Across 109 of 109 payment localities, the office rate for 99305 runs from $130.78 in Arkansas to $183.35 in Alaska. Queens, NY pays $158.31. The RVUs are the same everywhere; the geographic indexes change the dollars.

99305 in Queens, NY vs other payment areas
  1. Queens, NY · this page$158.31
  2. Manhattan, NY · New York$158.15−$0.16
  3. NYC suburbs and Long Island, NY · New York$161.17+$2.86
  4. Poughkeepsie and northern NYC suburbs, NY · New York$150.86−$7.45
  5. Rest of New York · New York$136.59−$21.72
  6. Los Angeles, CA · California$151.77−$6.54
  7. Washington, DC area · District of Columbia$155.30−$3.01

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

Every other payment area

99305 in every other Medicare payment locality
Payment localityOfficeFacility
Miami, FLFlorida$152.25$130.35
Chicago, ILIllinois$149.58$128.43
AlaskaAlaska$183.35$160.94
AlabamaAlabama$131.91$113.50
ArkansasArkansas$130.78$112.71
ArizonaArizona$138.49$118.10
Bakersfield, CACalifornia$145.13$122.06
Chico, CACalifornia$144.52$121.46

99305 rates by state

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

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

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.

$130.78

$183.35

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

View every state and territory as a table
99305 office rate range by state
State / territoryOffice rate rangeLocalities
AK$183.351
AL$131.911
AR$130.781
AZ$138.491
CA$144.52–$170.0829
CO$143.931
CT$147.851
DC$155.301
DE$140.141
FL$141.71–$152.253
GA$136.55–$143.232
GU$145.471
HI$145.471
IA$132.951
ID$133.671
IL$139.86–$149.584
IN$134.111
KS$133.031
KY$134.731
LA$134.78–$138.732
MA$143.79–$153.692
MD$141.91–$155.303
ME$134.56–$138.272
MI$137.25–$143.282
MN$138.211
MO$133.70–$138.493
MS$132.231
MT$140.941
NC$135.341
ND$137.381
NE$133.251
NH$142.311
NJ$149.61–$154.852
NM$137.891
NV$140.001
NY$136.59–$161.175
OH$136.521
OK$134.111
OR$138.96–$146.462
PA$136.40–$145.722
PR$141.431
RI$143.591
SC$136.141
SD$136.961
TN$133.491
TX$135.90–$143.528
UT$137.251
VA$138.31–$155.302
VI$141.431
VT$137.471
WA$143.33–$155.702
WI$134.631
WV$136.801
WY$139.391

See 99305 in every payment locality

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.

How the rate is built · 99305

RVUs × geographic indexes × conversion factor

Office or facility?

Work2.50

2.50 RVUs× 1.000 GPCI

Practice expense1.54

1.54 RVUs× 1.000 GPCI

Malpractice0.18

0.18 RVUs× 1.000 GPCI

Adjusted RVUs

4.2200

Conversion factor

$33.4009

Medicare rate

$140.95

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

The exact Queens, NY inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

13,046

Code
99305
Physician work
2.50
Practice expense
1.54
Malpractice
0.18

GPCI2026.csv

81

Locality
Queens, NY
Physician work
1.064
Practice expense
1.182
Malpractice
1.442
Office calculation for 99305 in Queens, NY
ComponentRVULocality factorAdjusted
Physician work2.50× 1.0642.6600
Practice expense1.54× 1.1821.8203
Malpractice0.18× 1.4420.2596
Total RVUs4.7398
Conversion factor× 33.4009

Office rate, Queens, NY$158.31

Office: (2.5 × 1.064 + 1.54 × 1.182 + 0.18 × 1.442) × $33.4009 = $158.31

Facility: (2.5 × 1.064 + 0.91 × 1.182 + 0.18 × 1.442) × $33.4009 = $133.44

Open 99305 in the RVU calculator

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.

Place of service · 99305

Which rate does Medicare pay?

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

POS 11 · non-facility rate · national

$140.95

Non-facility (office)
$140.95
Facility
$119.91

Higher because the practice carries its own overhead.

Codes related to 99305

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

Codes related to 99305
CodeHow it relatesOffice range, Queens, NY
Same family
99304Nursing facility care, initial, straightforward or low complexityInitial nursing facility care with straightforward or low MDM or at least 25 minutes.$90.81
99306Nursing facility visit, initial visit, high complexityInitial nursing facility care with high MDM or at least 50 minutes.$216.40
99309Nursing facility visit, subsequent, moderate MDM or 30 minutesSubsequent nursing facility care with moderate MDM or at least 30 minutes.$129.06
99307Nursing facility visit, subsequent visit, straightforward MDMSubsequent nursing facility care with straightforward MDM or at least 10 minutes.$47.42
Often billed with
99238Hospital discharge, 30 minutes or lessHospital discharge management may be reported with same-day initial nursing facility care.No office rate
Used instead
99344Home visit, new patient, moderate complexityModerate-level new-patient visit in a home or residence rather than a nursing facility.$163.39

How 99305 has changed in Queens, NY

99305 · Office / nonfacility

$158.31

Effective 2026-10-01

The base rate is $13.98 higher than on 2025-10-01, moving from $144.33 to $158.31 (9.7%).

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

    $144.33changed to$158.31

    • Conversion factor 32.3465 changed to 33.4009
    • Practice expense RVU 1.31 changed to 1.54
    • Malpractice RVU 0.16 changed to 0.18
    • Work GPCI 1.065 changed to 1.064
    • Practice expense GPCI 1.195 changed to 1.182
    • Malpractice GPCI 1.462 changed to 1.442

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $148.61changed to$144.33

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 1.30 changed to 1.31
    • Malpractice RVU 0.17 changed to 0.16

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $146.19changed to$148.61

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $154.21changed to$146.19

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 1.26 changed to 1.30
    • Malpractice RVU 0.18 changed to 0.17
    • Work GPCI 1.061 changed to 1.065
    • Practice expense GPCI 1.212 changed to 1.195
    • Malpractice GPCI 2.061 changed to 1.462

  5. January 1, 2023

    RVU23A

    $150.62changed to$154.21

    • Conversion factor 34.6062 changed to 33.8872
    • Work RVU 2.35 changed to 2.50
    • Practice expense RVU 1.22 changed to 1.26
    • Malpractice RVU 0.14 changed to 0.18
    • Work GPCI 1.056 changed to 1.061
    • Practice expense GPCI 1.228 changed to 1.212
    • Malpractice GPCI 2.661 changed to 2.061

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $152.37changed to$150.62

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 1.21 changed to 1.22
    • Malpractice RVU 0.15 changed to 0.14

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $151.87changed to$152.37

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 1.17 changed to 1.21
    • Malpractice RVU 0.13 changed to 0.15
    • Work GPCI 1.054 changed to 1.056
    • Practice expense GPCI 1.214 changed to 1.228
    • Malpractice GPCI 2.391 changed to 2.661

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $151.49changed to$151.87

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 1.16 changed to 1.17
    • Malpractice RVU 0.16 changed to 0.13
    • Work GPCI 1.052 changed to 1.054
    • Practice expense GPCI 1.200 changed to 1.214
    • Malpractice GPCI 2.121 changed to 2.391

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $151.86changed to$151.49

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 1.19 changed to 1.16
    • Malpractice RVU 0.15 changed to 0.16

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $151.12changed to$151.86

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 1.18 changed to 1.19
    • Malpractice GPCI 2.151 changed to 2.121

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $150.46changed to$151.12

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 1.17 changed to 1.18
    • Practice expense GPCI 1.199 changed to 1.200
    • Malpractice GPCI 2.181 changed to 2.151

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $151.43changed to$150.46

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 1.18 changed to 1.17

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $150.68changed to$151.43

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $152.08changed to$150.68

    • Conversion factor 35.8228 changed to 35.7547
    • Malpractice RVU 0.19 changed to 0.15
    • Work GPCI 1.057 changed to 1.052
    • Practice expense GPCI 1.197 changed to 1.199
    • Malpractice GPCI 1.836 changed to 2.181

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $146.69changed to$152.08

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 1.27 changed to 1.18
    • Malpractice RVU 0.20 changed to 0.19
    • Work GPCI 1.062 changed to 1.057
    • Practice expense GPCI 1.195 changed to 1.197
    • Malpractice GPCI 1.491 changed to 1.836

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $146.69

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$158.31$133.44RVU26D
2026-07-01$158.31$133.44RVU26C
2026-04-01$158.31$133.44RVU26B
2026-01-01$158.31$133.44RVU26A
2025-10-01$144.33$144.33RVU25D
2025-07-01$144.33$144.33RVU25C
2025-04-01$144.33$144.33RVU25B
2025-01-01$144.33$144.33RVU25A
2024-10-01$148.61$148.61RVU24D
2024-07-01$148.61$148.61RVU24C
2024-04-01$148.61$148.61RVU24B
2024-03-09$148.61$148.61RVU24AR
2024-01-01$146.19$146.19RVU24A
2023-10-01$154.21$154.21RVU23D
2023-07-01$154.21$154.21RVU23C
2023-04-01$154.21$154.21RVU23B
2023-01-01$154.21$154.21RVU23A
2022-10-01$150.62$150.62RVU22D
2022-07-01$150.62$150.62RVU22C
2022-04-01$150.62$150.62RVU22B
2022-01-01$150.62$150.62RVU22A
2021-10-01$152.37$152.37RVU21D
2021-07-01$152.37$152.37RVU21C
2021-04-01$152.37$152.37RVU21B
2021-01-01$152.37$152.37RVU21A
2020-10-01$151.87$151.87RVU20D
2020-07-01$151.87$151.87RVU20C
2020-04-01$151.87$151.87RVU20B
2020-01-01$151.87$151.87RVU20A
2019-10-01$151.49$151.49RVU19D
2019-07-01$151.49$151.49RVU19C
2019-04-01$151.49$151.49RVU19B
2019-01-01$151.49$151.49RVU19A
2018-10-01$151.86$151.86RVU18D
2018-07-01$151.86$151.86RVU18C
2018-04-01$151.86$151.86RVU18B
2018-01-01$151.86$151.86RVU18AR1
2017-10-01$151.12$151.12RVU17D
2017-07-01$151.12$151.12RVU17C
2017-04-01$151.12$151.12RVU17B
2017-01-01$151.12$151.12RVU17A
2016-10-01$150.46$150.46RVU16D
2016-07-01$150.46$150.46RVU16C
2016-04-01$150.46$150.46RVU16B
2016-01-01$150.46$150.46RVU16A
2015-10-01$151.43$151.43RVU15D
2015-07-01$151.43$151.43RVU15C
2015-04-01$150.68$150.68RVU15B
2015-01-01$150.68$150.68RVU15A
2014-10-01$152.08$152.08RVU14D
2014-07-01$152.08$152.08RVU14C
2014-04-01$152.08$152.08RVU14B
2014-01-01$152.08$152.08RVU14A
2013-10-01$146.69$146.69RVU13D
2013-07-01$146.69$146.69RVU13C
2013-04-01$146.69$146.69RVU13B
2013-01-01$146.69$146.69RVU13AR

Price 99305 for an earlier date of service

Where the Queens, NY rate applies

Queens, NY is a Medicare payment area, not a city. Our Census mapping connects it to 1 cities and communities in New York. Some span more than one payment area; confirm with the service ZIP.

Browse all communities in New York

99305 billing questions

How do I choose between 99304, 99305, and 99306?

Compare MDM or total practitioner time on the encounter date. 99304 describes straightforward or low MDM or at least 25 minutes; 99305 requires moderate MDM or at least 35 minutes; 99306 requires high MDM or at least 50 minutes.

Can 99305 be used for an established patient?

Yes. An initial nursing facility visit can be reported when the practitioner previously saw the patient in another setting. A later visit during the facility stay is generally reported with a subsequent nursing facility care code.

Can the same physician bill hospital discharge and 99305 on the same day?

Yes. Medicare permits a hospital discharge service (99238 or 99239) and initial nursing facility care on the same date when the patient leaves the hospital and is admitted to the facility that day.

What is modifier AI and when is it added to 99305?

Modifier AI identifies the principal physician of record on the initial nursing facility care claim. Another physician reporting an initial visit uses the appropriate initial care code without AI.

Can a nurse practitioner report 99305?

In a skilled nursing facility, a physician must perform the federally required initial comprehensive visit; a nurse practitioner may provide medically necessary visits beforehand using subsequent care codes. In a nursing facility, a nurse practitioner who is not employed by the facility may perform the initial comprehensive visit when permitted by state law and delegated by the physician.

What happens to an office or ED visit by the same practitioner on the admission date?

An E/M service the same practitioner provides at another site in conjunction with the nursing facility admission is included in initial nursing facility care rather than reported separately.

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 99305PPRRVU2026_Oct_nonQPP.csv, line 13,046 (RVU26D)
Geographic factors for Queens, NYGPCI2026.csv, line 81 (RVU26D)

Open CMS sourceHow we calculate rates

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