CPT code 99345: Home visit, new patient, high complexity2026 Medicare rate & RVUs in Puerto Rico

In Puerto Rico, Medicare pays $210.76 for 99345 in the office.

Check a contract rate as a % of Medicare · 99345 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 99345 covers

This service covers a comprehensive evaluation and management visit for a new patient seen in a private home or another residence, such as an assisted-living setting. A physician or qualified health care professional may address serious or worsening conditions, review relevant records and test results, and make high-risk treatment decisions. The code is for a patient meeting the CPT new-patient definition for the physician or qualified professional’s specialty and group.

Select this level when medical decision making is high, or when the practitioner’s total qualifying time on the date of service reaches at least 75 minutes. For high medical decision making, the documentation should support the complexity of the problems addressed, the data reviewed or analyzed, and the risk of management decisions. Record the residence, clinical assessment, decisions, and any qualifying time used to select the level. Do not include staff time or time spent on separately reported services in the E/M time total.

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 Puerto Rico compares for 99345

Across 109 of 109 payment localities, the office rate for 99345 runs from $195.87 in Arkansas to $275.83 in Alaska. Puerto Rico pays $210.76. The RVUs are the same everywhere; the geographic indexes change the dollars.

Every other payment area

99345 rates by state

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

See 99345 in every payment locality

How the 99345 rate is calculated

Each of 99345’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 99345

99345 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 99345

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

How 99345 has changed in Puerto Rico

Price 99345 for an earlier date of service

Where the Puerto Rico rate applies

Puerto Rico is a Medicare payment area, not a city. Our Census mapping connects it to 292 cities and communities in Puerto Rico. Some span more than one payment area; confirm with the service ZIP.

• Aceitunas
• Adjuntas
• Aguada
• Aguadilla
• Aguas Buenas
• Aguas Claras
• Aguilita
• Aibonito

Browse all communities in Puerto Rico

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