$80.55–$85.74
99348 is the low-decision-making established patient home visit, with a 30-minute minimum when selected by time. Choose 99349 for moderate decision making, supported by two of its three elements, or at least 40 minutes.
On this page
CMS RVU26D · Effective 2026-10-01
99349 Home visit Medicare reimbursement rates in Massachusetts
Report an established patient home or residence visit when medical decision making is moderate or the reporting practitioner spends at least 40 minutes on the visit date. Compare 99349 office and facility rates across CMS payment localities in Massachusetts.
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 99349 in Massachusetts?
Massachusetts has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
$134.89–$143.83
2 of 2 localities have a supported rate.
Facility setting
No supported rate
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 99349: Established patient home or residence visit, moderate complexity
Report an established patient home or residence visit when medical decision making is moderate or the reporting practitioner spends at least 40 minutes on the visit date.
This visit covers evaluation and management of an established patient in a private home or another residence, such as an assisted living facility or group home, rather than a nursing facility. Physicians, nurse practitioners, and physician assistants commonly perform these visits in house-call and home-based primary care programs. Patients may have limited mobility and several chronic conditions, such as heart failure, diabetes, or COPD, requiring assessment of a worsening problem or a medication change.
Select this level by moderate medical decision making or at least 40 minutes of the reporting practitioner’s qualifying time on the visit date. For decision making, document the problems addressed, relevant data reviewed, and management risk; two of those three elements must support the level. For time-based selection, record total minutes, including qualifying non-face-to-face work that day but excluding travel, staff time, and separately billed services. The former domiciliary and rest home visit settings are included in this home or residence visit family. Report the place of service that identifies where the patient was seen.
Where the value comes from
- Work RVU2.44 · 62%
- Practice expense (office) RVU1.36 · 34%
- Malpractice RVU0.16 · 4%
3.7M
Medicare services in 2024 · #51 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.
99349 compared with similar codes
Office rates for Massachusetts, from the same CMS release.
$196.79–$209.68
99350 requires high medical decision making or at least 60 minutes of qualifying time. Choose 99349 when decision making is moderate or its 40-minute time threshold is met without reaching the higher time threshold.
$149.49–$158.78
99344 is a moderate-decision-making home visit for a new patient, with a 60-minute minimum when selected by time. Use 99349 when the patient is established and its decision-making or time requirement is met.
$139.22–$150.68
99214 is the moderate-level established patient visit in an office or other outpatient setting. For an established patient seen at home or in another qualifying residence, select from the home or residence visit family.
Compare 99349 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.
2 of 2 payment localities
Metropolitan Boston →
Office / nonfacility
$143.83
Facility
Unavailable
Rest Of Massachusetts →
Office / nonfacility
$134.89
Facility
Unavailable
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99349 billing questions
When is 99349 chosen over 99348 or 99350?
Choose 99349 for moderate medical decision making or at least 40 minutes of qualifying practitioner time. When selecting by time, 99348 has a 30-minute minimum and 99350 has a 60-minute minimum; choose the highest level whose minimum is met.
Can 99349 be billed for visits in an assisted living facility?
Yes. Assisted living facilities and group homes are residential settings covered by the home or residence visit family. Use the place-of-service code for the actual setting.
Does Medicare require the patient to be homebound for 99349?
No. A medically necessary practitioner visit may be reported even if the patient is not homebound; homebound status concerns eligibility for home health services.
What counts toward the 40-minute threshold?
Count the reporting practitioner’s qualifying work on the visit date, including the visit, record review, care-related caregiver discussion, ordering, and documentation. Exclude travel, staff time, and time spent on separately billed services.
Can prolonged services be added to 99349?
Prolonged home or residence E/M services pair with the highest visit levels, 99345 and 99350, rather than 99349. A visit selected by time reaches 99350 at 60 minutes.
Is a new patient seen at home reported with 99349?
No. For a patient new to the practitioner and same-specialty, same-subspecialty group under the three-year new-patient rule, select from the new-patient home or residence codes, such as 99344 for moderate medical decision making.
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.
13,05799345,,Home/res vst new high mdm 75,A,,3.88,2.16,,2.16,NA,0.25,6.29,6.29,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,05899347,,Home/res vst est sf mdm 20,A,,0.90,0.44,,0.44,NA,0.04,1.38,1.38,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,05999348,,Home/res vst est low mdm 30,A,,1.50,0.79,,0.79,NA,0.07,2.36,2.36,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,06099349,,Home/res vst est mod mdm 40,A,,2.44,1.36,,1.36,NA,0.16,3.96,3.96,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,06199350,,Home/res vst est high mdm 60,A,,3.60,1.94,,1.94,NA,0.24,5.78,5.78,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,06299358,,Prolong service w/o contact,I,+,1.80,0.84,,0.39,,0.11,2.75,2.30,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,06399359,,Prolong serv w/o contact add,I,+,0.75,0.37,,0.17,,0.05,1.17,0.97,0,ZZZ,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00