99306 Nursing facility visit Medicare reimbursement rates in Massachusetts

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.