CPT code 99306: Nursing facility visit, initial visit, high complexity2026 Medicare rate & RVUs in North Dakota

An initial skilled nursing or nursing facility evaluation is reported at this level when high medical decision making or at least 50 minutes supports it.

CMS RVU26DEffective Oct 1, 2026One payment locality1.3M Medicare services in 2024

In North Dakota, Medicare pays $188.49 for 99306 in the office and $158.77 when it’s performed in a hospital or facility.

$188.49Office (non-facility)
$158.77Hospital or facility
−2.4%vs the national office rate ($193.06)

Check a contract rate as a % of Medicare · 99306 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 99306 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in North Dakota
  2. What 99306 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 99306 covers

Code 99306 covers an initial evaluation in a skilled nursing facility (SNF) or nursing facility when high medical decision making (MDM) or qualifying time supports the level. A practitioner may assess a resident after hospitalization for sepsis, stroke with swallowing problems, or worsening heart failure; those diagnoses alone do not establish high MDM. The visit may include reviewing hospital records, reconciling medications, examining the resident, and establishing a treatment plan. For Medicare SNF residents, a physician performs the required initial comprehensive visit; nurse practitioners and physician assistants may perform other medically necessary visits. In a nursing facility, an eligible practitioner not employed by the facility may perform the required initial comprehensive visit when permitted.

Select 99306 by high MDM, which requires two of three elements—problems, data, and risk—or by at least 50 minutes of the reporting practitioner's time on the encounter date. Document the clinical problems, data assessed, management decisions, or personally performed time. Exclude staff time and time spent on separately reported services. The principal physician of record appends Medicare modifier AI to the initial visit; other practitioners' qualifying initial visits are reported without AI. Later visits during the stay use subsequent nursing facility codes. Medicare prolonged time may be reported with G0317 when its threshold is met and 99306 was selected by time.

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 North Dakota compares for 99306

Across 109 of 109 payment localities, the office rate for 99306 runs from $179.68 in Arkansas to $252.51 in Alaska. North Dakota pays $188.49. The RVUs are the same everywhere; the geographic indexes change the dollars.

99306 in North Dakota vs other payment areas
  1. North Dakota · this page$188.49
  2. Los Angeles, CA · California$207.80+$19.31
  3. Washington, DC area · District of Columbia$212.43+$23.94
  4. Miami, FL · Florida$207.61+$19.12
  5. Chicago, IL · Illinois$204.17+$15.68
  6. Manhattan, NY · New York$216.13+$27.64
  7. Alaska · Alaska$252.51+$64.02

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

Every other payment area

99306 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$181.16$155.15
ArkansasArkansas$179.68$154.14
ArizonaArizona$189.83$161.02
Bakersfield, CACalifornia$198.85$166.27
Chico, CACalifornia$198.05$165.47
El Centro, CACalifornia$198.09$165.51
Fresno, CACalifornia$198.05$165.47
Hanford, CACalifornia$198.05$165.47

99306 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.

$179.68

$252.51

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

View every state and territory as a table
99306 office rate range by state
State / territoryOffice rate rangeLocalities
AK$252.511
AL$181.161
AR$179.681
AZ$189.831
CA$198.05–$232.6229
CO$197.161
CT$202.281
DC$212.431
DE$192.041
FL$193.91–$207.613
GA$187.14–$196.052
GU$199.201
HI$199.201
IA$182.601
ID$183.531
IL$191.43–$204.174
IN$184.111
KS$182.671
KY$184.801
LA$184.86–$190.062
MA$197.00–$210.292
MD$194.42–$212.433
ME$184.68–$189.612
MI$188.09–$195.932
MN$189.631
MO$183.41–$189.793
MS$181.531
MT$193.041
NC$185.701
ND$188.491
NE$183.011
NH$194.901
NJ$204.78–$211.902
NM$188.921
NV$191.841
NY$187.35–$220.065
OH$187.161
OK$184.021
OR$190.50–$200.562
PA$187.02–$199.452
PR$193.701
RI$196.711
SC$186.701
SD$187.961
TN$183.271
TX$186.35–$196.408
UT$188.171
VA$189.63–$212.432
VI$193.701
VT$188.581
WA$196.37–$213.042
WI$184.871
WV$187.401
WY$191.061

See 99306 in every payment locality

How the 99306 rate is calculated

Each of 99306’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 · 99306

RVUs × geographic indexes × conversion factor

Office or facility?

Work3.50

3.50 RVUs× 1.000 GPCI

Practice expense2.05

2.05 RVUs× 1.000 GPCI

Malpractice0.23

0.23 RVUs× 1.000 GPCI

Adjusted RVUs

5.7800

Conversion factor

$33.4009

Medicare rate

$193.06

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

The exact North Dakota inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

13,047

Code
99306
Physician work
3.50
Practice expense
2.05
Malpractice
0.23

GPCI2026.csv

84

Locality
North Dakota
Physician work
1.000
Practice expense
1.000
Malpractice
0.406
Office calculation for 99306 in North Dakota
ComponentRVULocality factorAdjusted
Physician work3.50× 1.0003.5000
Practice expense2.05× 1.0002.0500
Malpractice0.23× 0.4060.0934
Total RVUs5.6434
Conversion factor× 33.4009

Office rate, North Dakota$188.49

Office: (3.5 × 1 + 2.05 × 1 + 0.23 × 0.406) × $33.4009 = $188.49

Facility: (3.5 × 1 + 1.16 × 1 + 0.23 × 0.406) × $33.4009 = $158.77

Open 99306 in the RVU calculator

Payment rules and modifiers for 99306

99306 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 · 99306

Which rate does Medicare pay?

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

POS 11 · non-facility rate · national

$193.06

Non-facility (office)
$193.06
Facility
$163.33

Higher because the practice carries its own overhead.

How 99306 has changed in North Dakota

99306 · Office / nonfacility

$188.49

Effective 2026-10-01

The base rate is $16.61 higher than on 2025-10-01, moving from $171.88 to $188.49 (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

    $171.88changed to$188.49

    • Conversion factor 32.3465 changed to 33.4009
    • Practice expense RVU 1.70 changed to 2.05
    • Malpractice RVU 0.22 changed to 0.23
    • Malpractice GPCI 0.517 changed to 0.406

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $176.72changed to$171.88

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 1.69 changed to 1.70
    • Malpractice RVU 0.23 changed to 0.22

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $173.84changed to$176.72

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $178.39changed to$173.84

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 1.66 changed to 1.69
    • Malpractice RVU 0.22 changed to 0.23
    • Malpractice GPCI 0.474 changed to 0.517
  5. January 1, 2023

    RVU23A

    $160.79changed to$178.39

    • Conversion factor 34.6062 changed to 33.8872
    • Work RVU 3.06 changed to 3.50
    • Practice expense RVU 1.50 changed to 1.66
    • Malpractice RVU 0.20 changed to 0.22
    • Malpractice GPCI 0.431 changed to 0.474

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $162.47changed to$160.79

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 1.51 changed to 1.50

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $166.45changed to$162.47

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 1.46 changed to 1.51
    • Malpractice RVU 0.19 changed to 0.20
    • Malpractice GPCI 0.485 changed to 0.431

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $166.23changed to$166.45

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 1.45 changed to 1.46
    • Malpractice GPCI 0.540 changed to 0.485

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $166.77changed to$166.23

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 1.47 changed to 1.45

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $165.95changed to$166.77

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 1.46 changed to 1.47
    • Malpractice GPCI 0.547 changed to 0.540

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $164.53changed to$165.95

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 1.43 changed to 1.46
    • Malpractice GPCI 0.554 changed to 0.547

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $165.48changed to$164.53

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 1.44 changed to 1.43

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $164.66changed to$165.48

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $165.07changed to$164.66

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 1.43 changed to 1.44
    • Malpractice RVU 0.22 changed to 0.19
    • Malpractice GPCI 0.536 changed to 0.554

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $160.55changed to$165.07

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 1.54 changed to 1.43
    • Malpractice RVU 0.23 changed to 0.22
    • Malpractice GPCI 0.517 changed to 0.536

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $160.55

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$188.49$158.77RVU26D
2026-07-01$188.49$158.77RVU26C
2026-04-01$188.49$158.77RVU26B
2026-01-01$188.49$158.77RVU26A
2025-10-01$171.88$171.88RVU25D
2025-07-01$171.88$171.88RVU25C
2025-04-01$171.88$171.88RVU25B
2025-01-01$171.88$171.88RVU25A
2024-10-01$176.72$176.72RVU24D
2024-07-01$176.72$176.72RVU24C
2024-04-01$176.72$176.72RVU24B
2024-03-09$176.72$176.72RVU24AR
2024-01-01$173.84$173.84RVU24A
2023-10-01$178.39$178.39RVU23D
2023-07-01$178.39$178.39RVU23C
2023-04-01$178.39$178.39RVU23B
2023-01-01$178.39$178.39RVU23A
2022-10-01$160.79$160.79RVU22D
2022-07-01$160.79$160.79RVU22C
2022-04-01$160.79$160.79RVU22B
2022-01-01$160.79$160.79RVU22A
2021-10-01$162.47$162.47RVU21D
2021-07-01$162.47$162.47RVU21C
2021-04-01$162.47$162.47RVU21B
2021-01-01$162.47$162.47RVU21A
2020-10-01$166.45$166.45RVU20D
2020-07-01$166.45$166.45RVU20C
2020-04-01$166.45$166.45RVU20B
2020-01-01$166.45$166.45RVU20A
2019-10-01$166.23$166.23RVU19D
2019-07-01$166.23$166.23RVU19C
2019-04-01$166.23$166.23RVU19B
2019-01-01$166.23$166.23RVU19A
2018-10-01$166.77$166.77RVU18D
2018-07-01$166.77$166.77RVU18C
2018-04-01$166.77$166.77RVU18B
2018-01-01$166.77$166.77RVU18AR1
2017-10-01$165.95$165.95RVU17D
2017-07-01$165.95$165.95RVU17C
2017-04-01$165.95$165.95RVU17B
2017-01-01$165.95$165.95RVU17A
2016-10-01$164.53$164.53RVU16D
2016-07-01$164.53$164.53RVU16C
2016-04-01$164.53$164.53RVU16B
2016-01-01$164.53$164.53RVU16A
2015-10-01$165.48$165.48RVU15D
2015-07-01$165.48$165.48RVU15C
2015-04-01$164.66$164.66RVU15B
2015-01-01$164.66$164.66RVU15A
2014-10-01$165.07$165.07RVU14D
2014-07-01$165.07$165.07RVU14C
2014-04-01$165.07$165.07RVU14B
2014-01-01$165.07$165.07RVU14A
2013-10-01$160.55$160.55RVU13D
2013-07-01$160.55$160.55RVU13C
2013-04-01$160.55$160.55RVU13B
2013-01-01$160.55$160.55RVU13AR

Price 99306 for an earlier date of service

Where the North Dakota rate applies

North Dakota is a Medicare payment area, not a city. Our Census mapping connects it to 406 cities and communities in North Dakota. Some span more than one payment area; confirm with the service ZIP.

  • Abercrombie
  • Adams
  • Alamo
  • Alexander
  • Alice
  • Almont
  • Alsen
  • Ambrose

Browse all communities in North Dakota

99306 billing questions

When should 99306 be chosen over 99305?

Both are initial nursing facility visits. Choose 99306 for high MDM or at least 50 minutes of qualifying time; 99305 requires moderate MDM or at least 35 minutes. When selecting by MDM, document the elements supporting the higher level.

What is modifier AI and when is it appended?

For Medicare, modifier AI identifies the principal physician of record on an initial nursing facility visit. Other practitioners who perform qualifying initial visits report them without AI.

Can a nurse practitioner bill 99306?

A physician must perform the required initial comprehensive visit for a Medicare SNF resident, but a nurse practitioner may report another medically necessary initial visit when supported. In a nursing facility, a qualified nurse practitioner not employed by the facility may perform the required initial comprehensive visit when permitted.

How is prolonged time reported with 99306?

Medicare uses G0317 when the applicable prolonged-service threshold is met; payers following CPT may use 99418. The primary visit must be selected by time, and the prolonged-service requirements must also be met.

Can 99306 be billed if the patient was seen by the same practitioner earlier in the stay?

After that practitioner's initial visit, later visits during the same stay are reported with subsequent nursing facility codes 99307–99310. A new admission after discharge may support another initial visit.

Does activity on other days count toward the 50 minutes?

No. Count only the reporting practitioner's qualifying time on the encounter date, such as chart review, examination, orders, and documentation. Exclude facility staff time and time spent on separately reported services.

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 99306PPRRVU2026_Oct_nonQPP.csv, line 13,047 (RVU26D)
Geographic factors for North DakotaGPCI2026.csv, line 84 (RVU26D)

Open CMS sourceHow we calculate rates

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