$171.51
99310 is a subsequent nursing facility visit at high complexity; 99306 is for a qualifying initial visit during the resident's stay.
On this page
CMS RVU26D · Effective 2026-10-01
99306 Nursing facility visit Medicare reimbursement rates in Connecticut
An initial skilled nursing or nursing facility evaluation is reported at this level when high medical decision making or at least 50 minutes supports it. Compare 99306 office and facility rates across CMS payment localities in Connecticut.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 99306 in Connecticut?
Connecticut has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
$202.28
1 of 1 localities have a supported rate.
Payment area: Connecticut
One mapped payment locality.
Facility setting
$170.27
1 of 1 localities have a supported rate.
Payment area: Connecticut
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Evaluation and management
About 99306: Initial nursing facility visit, high complexity
An initial skilled nursing or nursing facility evaluation is reported at this level when high medical decision making or at least 50 minutes supports it.
Code 99306 covers an initial evaluation in a skilled nursing facility (SNF) or nursing facility when high medical decision making (MDM) or qualifying time supports the level. A practitioner may assess a resident after hospitalization for sepsis, stroke with swallowing problems, or worsening heart failure; those diagnoses alone do not establish high MDM. The visit may include reviewing hospital records, reconciling medications, examining the resident, and establishing a treatment plan. For Medicare SNF residents, a physician performs the required initial comprehensive visit; nurse practitioners and physician assistants may perform other medically necessary visits. In a nursing facility, an eligible practitioner not employed by the facility may perform the required initial comprehensive visit when permitted.
Select 99306 by high MDM, which requires two of three elements—problems, data, and risk—or by at least 50 minutes of the reporting practitioner's time on the encounter date. Document the clinical problems, data assessed, management decisions, or personally performed time. Exclude staff time and time spent on separately reported services. The principal physician of record appends Medicare modifier AI to the initial visit; other practitioners' qualifying initial visits are reported without AI. Later visits during the stay use subsequent nursing facility codes. Medicare prolonged time may be reported with G0317 when its threshold is met and 99306 was selected by time.
Where the value comes from
- Work RVU3.50 · 61%
- Practice expense (office) RVU2.05 · 35%
- Malpractice RVU0.23 · 4%
1.3M
Medicare services in 2024 · #117 by national volume
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.
99306 compared with similar codes
Office rates for Connecticut, from the same CMS release.
No office rate
99223 is an initial hospital inpatient or observation visit; 99306 is for an initial evaluation of a resident in a skilled nursing facility or nursing facility.
$219.99
99345 covers high-level home or residence visits, including assisted living; 99306 is for patients in a skilled nursing facility or nursing facility.
$147.85
99305 requires moderate MDM or at least 35 minutes for an initial nursing facility visit. Choose 99306 when high MDM or at least 50 minutes is supported.
Compare 99306 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Connecticut →
Office / nonfacility
$202.28
Facility
$170.27
Need rates for a whole code list?
Fee-sheet and API access are in early access. Tell us which codes and locations your team needs.
How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 99306 in Connecticut.
PPRRVU2026_Oct_nonQPP.csv
13,047
- Code
- 99306
- Physician work
- 3.50
- Practice expense
- 2.05
- Malpractice
- 0.23
GPCI2026.csv
38
- Locality
- Connecticut
- Physician work
- 1.020
- Practice expense
- 1.077
- Malpractice
- 1.210
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 3.50 | × 1.020 | 3.5700 |
| Practice expense | 2.05 | × 1.077 | 2.2078 |
| Malpractice | 0.23 | × 1.210 | 0.2783 |
| Total RVUs | 6.0561 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Connecticut$202.28
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 3.5 | 1.02 |
| Practice expense | 2.05 | 1.077 |
| Malpractice | 0.23 | 1.21 |
(3.5 × 1.02 + 2.05 × 1.077 + 0.23 × 1.21) × $33.4009 = $202.28
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 3.5 | 1.02 |
| Practice expense | 1.16 | 1.077 |
| Malpractice | 0.23 | 1.21 |
(3.5 × 1.02 + 1.16 × 1.077 + 0.23 × 1.21) × $33.4009 = $170.27
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
99306 billing questions
When should 99306 be chosen over 99305?
Both are initial nursing facility visits. Choose 99306 for high MDM or at least 50 minutes of qualifying time; 99305 requires moderate MDM or at least 35 minutes. When selecting by MDM, document the elements supporting the higher level.
What is modifier AI and when is it appended?
For Medicare, modifier AI identifies the principal physician of record on an initial nursing facility visit. Other practitioners who perform qualifying initial visits report them without AI.
Can a nurse practitioner bill 99306?
A physician must perform the required initial comprehensive visit for a Medicare SNF resident, but a nurse practitioner may report another medically necessary initial visit when supported. In a nursing facility, a qualified nurse practitioner not employed by the facility may perform the required initial comprehensive visit when permitted.
How is prolonged time reported with 99306?
Medicare uses G0317 when the applicable prolonged-service threshold is met; payers following CPT may use 99418. The primary visit must be selected by time, and the prolonged-service requirements must also be met.
Can 99306 be billed if the patient was seen by the same practitioner earlier in the stay?
After that practitioner's initial visit, later visits during the same stay are reported with subsequent nursing facility codes 99307–99310. A new admission after discharge may support another initial visit.
Does activity on other days count toward the 50 minutes?
No. Count only the reporting practitioner's qualifying time on the encounter date, such as chart review, examination, orders, and documentation. Exclude facility staff time and time spent on separately reported services.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
13,04499292,,Critical care addl 30 min,A,,2.25,1.53,,0.52,,0.23,4.01,3.00,0,ZZZ,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,04599304,,1st nf care sf/low mdm 25,A,,1.50,0.84,,0.54,,0.09,2.43,2.13,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,04699305,,1st nf care moderate mdm 35,A,,2.50,1.54,,0.91,,0.18,4.22,3.59,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,04799306,,1st nf care high mdm 50,A,,3.50,2.05,,1.16,,0.23,5.78,4.89,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,04899307,,Sbsq nf care sf mdm 10,A,,0.70,0.51,,0.36,,0.05,1.26,1.11,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,04999308,,Sbsq nf care low mdm 20,A,,1.30,0.98,,0.65,,0.08,2.36,2.03,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,05099309,,Sbsq nf care moderate mdm 30,A,,1.92,1.37,,0.89,,0.14,3.43,2.95,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3501112,CA,70,YUBA CITY,1.017,1.096,0.536
3601112,CA,75,REST OF CALIFORNIA,1.017,1.096,0.536
3704112,CO,01,COLORADO,1.012,1.064,0.781
3813102,CT,00,CONNECTICUT,1.020,1.077,1.210
3912202,DC,01,DC + MD/VA SUBURBS,1.054,1.178,1.113
4012102,DE,01,DELAWARE,1.005,0.988,0.899
4109102,FL,03,FORT LAUDERDALE,1.000,1.013,1.808