CPT code 99349: Home visit, established patient, moderate complexity2026 Medicare rate & RVUs in Missouri
Report an established patient home or residence visit when medical decision making is moderate or the reporting practitioner spends at least 40 minutes on the visit date.
Medicare pays $125.86–$130.10 for 99349 in the office in Missouri, from Rest of Missouri to Metropolitan St. Louis, MO. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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On this page 9 sections
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 in Missouri
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
3 payment localities
$125.86 to $130.10
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Kansas City, MO | $129.37 | Unavailable |
| Metropolitan St. Louis, MO | $130.10 | Unavailable |
| Rest of Missouri | $125.86 | Unavailable |
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.
How the rate is built · 99349
RVUs × geographic indexes × conversion factor
Work2.44
2.44 RVUs× 1.000 GPCI
Practice expense1.36
1.36 RVUs× 1.000 GPCI
Malpractice0.16
0.16 RVUs× 1.000 GPCI
Adjusted RVUs
3.9600
Conversion factor
$33.4009
Medicare rate
$132.27
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
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.
Place of service · 99349
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
POS 11 · non-facility rate · national
$132.27
Higher because the practice carries its own overhead.
99349 compared with similar codes
Compare codes · National
5 codes, side by side
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.
99349 billing questions
When is 99349 chosen over 99348 or 99350?
Choose 99349 for moderate medical decision making or at least 40 minutes of qualifying practitioner time. When selecting by time, 99348 has a 30-minute minimum and 99350 has a 60-minute minimum; choose the highest level whose minimum is met.
Can 99349 be billed for visits in an assisted living facility?
Yes. Assisted living facilities and group homes are residential settings covered by the home or residence visit family. Use the place-of-service code for the actual setting.
Does Medicare require the patient to be homebound for 99349?
No. A medically necessary practitioner visit may be reported even if the patient is not homebound; homebound status concerns eligibility for home health services.
What counts toward the 40-minute threshold?
Count the reporting practitioner’s qualifying work on the visit date, including the visit, record review, care-related caregiver discussion, ordering, and documentation. Exclude travel, staff time, and time spent on separately billed services.
Can prolonged services be added to 99349?
Prolonged home or residence E/M services pair with the highest visit levels, 99345 and 99350, rather than 99349. A visit selected by time reaches 99350 at 60 minutes.
Is a new patient seen at home reported with 99349?
No. For a patient new to the practitioner and same-specialty, same-subspecialty group under the three-year new-patient rule, select from the new-patient home or residence codes, such as 99344 for moderate medical decision making.
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
Show the CMS file lines behind this rate
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