99342 Home visit Medicare reimbursement rates in Maine

99342 is for an E/M encounter with a new patient in a private home or another residence, such as an assisted living residence or group home. A physician or qualified health care professional assesses the patient’s concerns, relevant history and examination findings, and develops or updates a plan. The code fits low-level decision making, such as management of stable chronic conditions or an uncomplicated acute concern, when the documented work supports that level. The patient must not have received professional services from the same physician or another clinician of the same specialty and group within the prior three years.

Select 99342 by low medical decision making or by the physician’s or qualified health care professional’s total time on the date of service; time-based reporting requires at least 30 minutes. Document the residence, the problems addressed, information reviewed, management risk, and time when used to select the level. A home visit alone does not establish this code: straightforward MDM supports a lower level, while moderate or high MDM points to a higher new-patient home/residence level. CMS assigns work, practice-expense, and malpractice relative values to this service in the physician fee schedule.