CMS RVU26D · Effective 2026-10-01
Report an initial nursing facility visit supported by moderate medical decision making or at least 35 minutes of practitioner time on the encounter date. Compare 99305 office and facility rates across CMS payment localities in Kentucky.
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.
Kentucky 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.
$134.73
1 of 1 localities have a supported rate.
Payment area: Kentucky
One mapped payment locality.
$116.02
1 of 1 localities have a supported rate.
Payment area: Kentucky
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
Report an initial nursing facility visit supported by moderate medical decision making or at least 35 minutes of practitioner time on the encounter date.
This initial visit evaluates a resident during a skilled nursing facility (POS 31) or nursing facility (POS 32) stay. The physician or qualified practitioner may review hospital records and transfer orders, reconcile medications, examine the resident, and establish a care plan. Attending physicians, geriatricians, and hospitalists who follow patients into post-acute care commonly perform this service. Nurse practitioners and physician assistants may also provide nursing facility care, subject to Medicare requirements governing the initial comprehensive visit.
Select 99305 using moderate medical decision making (MDM) or at least 35 minutes of the reporting practitioner's total time on the encounter date. Two of the three MDM elements—problems addressed, data reviewed or analyzed, and management risk—must support the level; multiple stable conditions or prescription management alone do not establish moderate MDM. Document the work supporting the selected method. Initial care can be reported for a patient previously seen by the practitioner in another setting. Under Medicare policy, the principal physician of record appends modifier AI to the initial nursing facility care code.
1.1M
Medicare services in 2024 · #134 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.
Office rates for Kentucky, from the same CMS release.
99309 is a subsequent nursing facility visit with moderate MDM or at least 30 minutes; it may also describe a medically necessary visit before the physician's required initial comprehensive visit. 99305 describes initial care and has a 35-minute time threshold.
99306 requires high MDM or at least 50 minutes; 99305 requires moderate MDM or at least 35 minutes. Select the level supported by the documented MDM or time.
99344 describes a new-patient home or residence visit, such as one in an assisted living facility. 99305 describes initial care in a skilled nursing facility or nursing facility.
99304 describes straightforward or low MDM or at least 25 minutes. Choose 99305 when two MDM elements support the moderate level or total practitioner time reaches 35 minutes.
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
Office / nonfacility
$134.73
Facility
$116.02
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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 99305 in Kentucky.
PPRRVU2026_Oct_nonQPP.csv
13,046
GPCI2026.csv
55
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 2.50 | × 1.000 | 2.5000 |
| Practice expense | 1.54 | × 0.889 | 1.3691 |
| Malpractice | 0.18 | × 0.915 | 0.1647 |
| Total RVUs | 4.0338 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Kentucky$134.73
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.5 | 1 |
| Practice expense | 1.54 | 0.889 |
| Malpractice | 0.18 | 0.915 |
(2.5 × 1 + 1.54 × 0.889 + 0.18 × 0.915) × $33.4009 = $134.73
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.5 | 1 |
| Practice expense | 0.91 | 0.889 |
| Malpractice | 0.18 | 0.915 |
(2.5 × 1 + 0.91 × 0.889 + 0.18 × 0.915) × $33.4009 = $116.02
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.
Compare MDM or total practitioner time on the encounter date. 99304 describes straightforward or low MDM or at least 25 minutes; 99305 requires moderate MDM or at least 35 minutes; 99306 requires high MDM or at least 50 minutes.
Yes. An initial nursing facility visit can be reported when the practitioner previously saw the patient in another setting. A later visit during the facility stay is generally reported with a subsequent nursing facility care code.
Yes. Medicare permits a hospital discharge service (99238 or 99239) and initial nursing facility care on the same date when the patient leaves the hospital and is admitted to the facility that day.
Modifier AI identifies the principal physician of record on the initial nursing facility care claim. Another physician reporting an initial visit uses the appropriate initial care code without AI.
In a skilled nursing facility, a physician must perform the federally required initial comprehensive visit; a nurse practitioner may provide medically necessary visits beforehand using subsequent care codes. In a nursing facility, a nurse practitioner who is not employed by the facility may perform the initial comprehensive visit when permitted by state law and delegated by the physician.
An E/M service the same practitioner provides at another site in conjunction with the nursing facility admission is included in initial nursing facility care rather than reported separately.
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.
