CPT code 99342: Home visit, new patient, low MDM2026 Medicare rate & RVUs in Washington, DC area

In Washington, DC area, Medicare pays $85.87 for 99342 in the office.

Check a contract rate as a % of Medicare · 99342 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 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.

How Washington, DC area compares for 99342

Across 109 of 109 payment localities, the office rate for 99342 runs from $74.68 in Arkansas to $106.72 in Alaska. Washington, DC area pays $85.87. The RVUs are the same everywhere; the geographic indexes change the dollars.

Every other payment area

99342 rates by state

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

See 99342 in every payment locality

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.

Codes related to 99342

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

How 99342 has changed in Washington, DC area

Price 99342 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