CPT code 99349: Home visit, established patient, moderate complexity2026 Medicare rate & RVUs

Medicare pays $132.27 for 99349 nationally in the office. Local office rates run $123.27–$173.57.

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

What 99349 covers

This visit covers evaluation and management of an established patient in a private home or another residence, such as an assisted living facility or group home, rather than a nursing facility. Physicians, nurse practitioners, and physician assistants commonly perform these visits in house-call and home-based primary care programs. Patients may have limited mobility and several chronic conditions, such as heart failure, diabetes, or COPD, requiring assessment of a worsening problem or a medication change.

Select this level by moderate medical decision making or at least 40 minutes of the reporting practitioner’s qualifying time on the visit date. For decision making, document the problems addressed, relevant data reviewed, and management risk; two of those three elements must support the level. For time-based selection, record total minutes, including qualifying non-face-to-face work that day but excluding travel, staff time, and separately billed services. The former domiciliary and rest home visit settings are included in this home or residence visit family. Report the place of service that identifies where the patient was seen.

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 99349 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

99349 rates by state

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

How the 99349 rate is calculated

Each of 99349’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 99349

99349 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.

99349 compared with similar codes

How to choose

99348Home visitEstablished patient, low MDM or 30 minutes

99348 is the low-decision-making established patient home visit, with a 30-minute minimum when selected by time. Choose 99349 for moderate decision making, supported by two of its three elements, or at least 40 minutes.

99350Home visitEstablished patient, high complexity

99350 requires high medical decision making or at least 60 minutes of qualifying time. Choose 99349 when decision making is moderate or its 40-minute time threshold is met without reaching the higher time threshold.

99344Home visitNew patient, moderate complexity

99344 is a moderate-decision-making home visit for a new patient, with a 60-minute minimum when selected by time. Use 99349 when the patient is established and its decision-making or time requirement is met.

99214Office visitEstablished patient, moderate complexity

99214 is the moderate-level established patient visit in an office or other outpatient setting. For an established patient seen at home or in another qualifying residence, select from the home or residence visit family.

Codes related to 99349

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