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

In Puerto Rico, Medicare pays $141.43 for 99305 in the office and $120.15 when it’s performed in a hospital or facility.

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.

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 Puerto Rico 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. Puerto Rico pays $141.43. The RVUs are the same everywhere; the geographic indexes change the dollars.

Every other payment area

99305 rates by state

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

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.

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.

Codes related to 99305

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

How 99305 has changed in Puerto Rico

Price 99305 for an earlier date of service

Where the Puerto Rico rate applies

Puerto Rico is a Medicare payment area, not a city. Our Census mapping connects it to 292 cities and communities in Puerto Rico. Some span more than one payment area; confirm with the service ZIP.

• Aceitunas
• Adjuntas
• Aguada
• Aguadilla
• Aguas Buenas
• Aguas Claras
• Aguilita
• Aibonito

Browse all communities in Puerto Rico

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