CPT code 99342: Home visit, new patient, low MDM2026 Medicare rate & RVUs

Medicare pays $78.83 for 99342 nationally in the office. Local office rates run $74.68–$106.72.

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

What 99342 covers

99342 is for an E/M encounter with a new patient in a private home or another residence, such as an assisted living residence or group home. A physician or qualified health care professional assesses the patient’s concerns, relevant history and examination findings, and develops or updates a plan. The code fits low-level decision making, such as management of stable chronic conditions or an uncomplicated acute concern, when the documented work supports that level. The patient must not have received professional services from the same physician or another clinician of the same specialty and group within the prior three years.

Select 99342 by low medical decision making or by the physician’s or qualified health care professional’s total time on the date of service; time-based reporting requires at least 30 minutes. Document the residence, the problems addressed, information reviewed, management risk, and time when used to select the level. A home visit alone does not establish this code: straightforward MDM supports a lower level, while moderate or high MDM points to a higher new-patient home/residence level. CMS assigns work, practice-expense, and malpractice relative values to this service in the physician fee schedule.

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 99342 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

99342 rates by state

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

How the 99342 rate is calculated

Each of 99342’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 99342

99342 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.

99342 compared with similar codes

How to choose

99341Home visitNew patient, straightforward MDM

Both are new-patient home or residence visits. Choose 99341 for straightforward MDM; 99342 requires low MDM or at least 30 minutes when selected by time.

99344Home visitNew patient, moderate complexity

Both are new-patient home or residence visits. 99344 represents moderate MDM or a higher time threshold; 99342 represents low MDM or at least 30 minutes.

99348Home visitEstablished patient, low MDM or 30 minutes

Both describe low-MDM home or residence visits, but 99348 is for an established patient and 99342 is for a new patient.

99306Nursing facility visitInitial visit, high complexity

99306 is for an initial nursing facility service at high MDM. Use the home or residence visit family when the encounter is furnished in a patient’s home or other residence.

Codes related to 99342

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

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