Billing code 99310: Nursing facility visitMedicare rate & RVUs

Medicare pays $163.33 for 99310 nationally in the office and $140.28 in a hospital or facility. Local office rates run $151.07–$211.02.

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

What 99310 covers

This is the highest level in the subsequent nursing facility E/M series. It covers a follow-up visit to a skilled nursing facility or long-term nursing facility resident after the initial evaluation. A practitioner might assess suspected sepsis, new respiratory failure, or a severe heart failure or COPD exacerbation and decide whether hospital transfer or a major change in treatment is needed. Attending physicians, geriatricians, nurse practitioners, and physician assistants commonly provide these visits during facility rounds.

Select 99310 when medical decision making is high or the reporting practitioner's qualifying time on the date of service reaches 45 minutes. High MDM requires two of three elements—problems, data, and management risk—at the high level; a hospitalization decision alone does not establish the overall level. Time may include examining the resident, reviewing records, coordinating with facility staff, and documenting, but excludes staff time and work counted toward another reported service. Document the supporting MDM elements or total qualifying time. If the visit is selected by time and Medicare's prolonged-service threshold is met, G0317 may be reported for eligible additional time.

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 99310 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

99310 rates by state

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

How the 99310 rate is calculated

Each of 99310’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 99310

99310 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.

99310 compared with similar codes

How to choose

99309Nursing facility visit

99309 describes moderate MDM or at least 30 minutes when the higher level is not met; 99310 requires high MDM or at least 45 minutes of qualifying time.

99306Nursing facility visit

99306 describes an initial nursing facility evaluation at high MDM; 99310 describes a subsequent nursing facility visit.

99350Home visit

99350 applies to established patients seen at home or in assisted living and similar residences; 99310 applies to residents in a skilled nursing facility or nursing facility.

99315Discharge management

99315 covers nursing facility discharge management of 30 minutes or less. Choose it instead of 99310 when the service furnished is discharge management.

Codes related to 99310

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