CPT code 99309: Nursing facility visit2026 Medicare rate & RVUs in Guam
Report a follow-up visit for a skilled nursing or nursing facility resident when the practitioner performs moderate medical decision making or spends at least 30 minutes.
Medicare pays $118.87 for 99309 in the office in Guam (Hawaii, Guam). 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.
On this page 9 sections
What 99309 covers
This follow-up visit addresses a resident in a skilled nursing facility or nursing facility. A typical moderate-MDM encounter involves worsening heart failure requiring a diuretic change, or management of two stable chronic conditions with prescription medications. Attending physicians, nurse practitioners, and physician assistants perform these visits during post-acute or long-term care rounds. The visit may include assessing changes in condition, reviewing facility records, discussing care with nursing staff, and updating treatment orders.
Select the level by medical decision making (MDM) or the reporting practitioner's total time on the encounter date. Time-based selection requires at least 30 minutes and can include chart review, discussions with nurses or family, orders, and documentation; exclude staff time and time spent on separately reported services. For MDM-based selection, at least two of three elements must reach the moderate level: problems addressed, data reviewed or ordered, and management risk. Document the clinical changes, treatment decisions, or time supporting the chosen level. Report the correct place of service: skilled nursing facility (POS 31) uses facility practice expense inputs, while nursing facility (POS 32) uses nonfacility inputs.
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.
99309 in Hawaii, Guam
| Payment locality | Office | Facility |
|---|---|---|
| Hawaii, Guam | $118.87 | $100.64 |
How the 99309 rate is calculated
Each of 99309’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 · 99309
RVUs × geographic indexes × conversion factor
Work1.92
1.92 RVUs× 1.000 GPCI
Practice expense1.37
1.37 RVUs× 1.000 GPCI
Malpractice0.14
0.14 RVUs× 1.000 GPCI
Adjusted RVUs
3.4300
Conversion factor
$33.4009
Medicare rate
$114.57
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 99309
99309 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 · 99309
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
POS 11 · non-facility rate · national
$114.57
- Non-facility (office)
- $114.57
- Facility
- $98.53
Higher because the practice carries its own overhead.
99309 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 99310Nursing facility visit
- 99310 requires high MDM or at least 45 minutes of practitioner time. Use 99309 for moderate MDM or when at least 30 minutes supports time-based selection but the 99310 threshold is not met.
- 99305Nursing facility visit
- 99305 is an initial nursing facility visit at moderate MDM or at least 35 minutes. 99309 is for a subsequent visit at moderate MDM or at least 30 minutes.
- 99349Home visit
- 99349 is a moderate-level established patient home or residence visit, including visits in assisted living. 99309 is for subsequent visits in skilled nursing facilities or nursing facilities.
- 99308Nursing facility visit
- 99308 requires low MDM or at least 20 minutes. For 99309, at least two MDM elements must reach moderate complexity, or practitioner time must reach 30 minutes.
99309 billing questions
When does a visit qualify as 99309 instead of 99308?
Choose 99309 when at least two MDM elements reach the moderate level or the reporting practitioner spends at least 30 minutes on the encounter date. Choose 99308 for low MDM or when at least 20 minutes supports time-based selection but the 99309 threshold is not met.
What counts toward the 30 minutes?
Count the reporting physician's or qualified health care professional's time on the encounter date, including the visit, record review, discussions with nurses or family, orders, and documentation. Exclude facility staff time, time on other dates, and time spent on separately reported services.
Can 99309 be reported for an assisted living resident?
No. Assisted living is a home or residence setting; select the appropriate home or residence E/M code based on the patient's status, MDM, or time. Nursing facility visit codes are for skilled nursing facilities and nursing facilities.
Can 99309 be reported on the same day as the discharge visit?
The practitioner reporting nursing facility discharge management uses 99315 or 99316 for work performed on the discharge date rather than also reporting a subsequent nursing facility visit for that work.
Is 99309 used for the first visit after a resident's readmission?
If the practitioner performs the initial nursing facility assessment for the readmission, select an initial visit code from 99304–99306. Use 99307–99310 for subsequent visits.
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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