CPT code 99309: Nursing facility visit, subsequent, moderate MDM or 30 minutes2026 Medicare rate & RVUs in Washington, DC area

In Washington, DC area, Medicare pays $126.70 for 99309 in the office and $107.82 when it’s performed in a hospital or facility.

Check a contract rate as a % of Medicare · 99309 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 99309 covers

This follow-up visit addresses a resident in a skilled nursing facility or nursing facility. A typical moderate-MDM encounter involves worsening heart failure requiring a diuretic change, or management of two stable chronic conditions with prescription medications. Attending physicians, nurse practitioners, and physician assistants perform these visits during post-acute or long-term care rounds. The visit may include assessing changes in condition, reviewing facility records, discussing care with nursing staff, and updating treatment orders.

Select the level by medical decision making (MDM) or the reporting practitioner's total time on the encounter date. Time-based selection requires at least 30 minutes and can include chart review, discussions with nurses or family, orders, and documentation; exclude staff time and time spent on separately reported services. For MDM-based selection, at least two of three elements must reach the moderate level: problems addressed, data reviewed or ordered, and management risk. Document the clinical changes, treatment decisions, or time supporting the chosen level. Report the correct place of service: skilled nursing facility (POS 31) uses facility practice expense inputs, while nursing facility (POS 32) uses nonfacility inputs.

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 Washington, DC area compares for 99309

Across 109 of 109 payment localities, the office rate for 99309 runs from $105.85 in Arkansas to $147.50 in Alaska. Washington, DC area pays $126.70. The RVUs are the same everywhere; the geographic indexes change the dollars.

Every other payment area

99309 rates by state

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

See 99309 in every payment locality

How the 99309 rate is calculated

Each of 99309’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 99309

99309 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 99309

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

How 99309 has changed in Washington, DC area

Price 99309 for an earlier date of service

Where the Washington, DC area rate applies

Washington, DC area is a Medicare payment area, not a city. Our Census mapping connects it to 1 cities and communities in District of Columbia. Some span more than one payment area; confirm with the service ZIP.

• Washington

Browse all communities in District of Columbia

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