CPT code 99306: Nursing facility visit, initial visit, high complexity2026 Medicare rate & RVUs in New York
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.
Medicare pays $187.35–$220.06 for 99306 in the office in New York, from Rest of New York to NYC suburbs and Long Island, NY. 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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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.
Where 99306 pays more and less in New York
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
5 payment localities
$187.35 to $220.06
| Payment locality | Office | Facility |
|---|---|---|
| Manhattan, NY | $216.13 | $181.59 |
| NYC suburbs and Long Island, NY | $220.06 | $184.72 |
| Poughkeepsie and northern NYC suburbs, NY | $206.44 | $173.89 |
| Queens, NY | $216.40 | $181.26 |
| Rest of New York | $187.35 | $159.11 |
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
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.
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.
99306 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 99310Nursing facility visitSubsequent visit, high MDM
- 99310 is a subsequent nursing facility visit at high complexity; 99306 is for a qualifying initial visit during the resident's stay.
- 99223Initial hospital visitHigh decision making or 75 minutes
- 99223 is an initial hospital inpatient or observation visit; 99306 is for an initial evaluation of a resident in a skilled nursing facility or nursing facility.
- 99345Home visitNew patient, high complexity
- 99345 covers high-level home or residence visits, including assisted living; 99306 is for patients in a skilled nursing facility or nursing facility.
- 99305Nursing facility visitInitial visit, moderate MDM
- 99305 requires moderate MDM or at least 35 minutes for an initial nursing facility visit. Choose 99306 when high MDM or at least 50 minutes is supported.
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
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