$133.70–$138.49
Both describe initial nursing facility care. Choose 99305 when the documented medical decision making is moderate complexity or its applicable time threshold is met; 99304 is for straightforward or low complexity or its threshold.
On this page
CMS RVU26D · Effective 2026-10-01
99304 Nursing facility care Medicare reimbursement rates in Missouri
Report this initial nursing facility evaluation when the documented medical decision making is straightforward or low complexity, or the service meets the 25-minute time threshold. Compare 99304 office and facility rates across CMS payment localities in Missouri.
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 99304 in Missouri?
Missouri has 3 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 3 payment areas shown below, using the same CMS release.
Office / nonfacility
$77.21–$79.82
3 of 3 localities have a supported rate.
Facility setting
$68.58–$70.28
3 of 3 localities have a 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.
Where 99304 pays more and less in Missouri
3 payment localities
$77.21 to $79.82
Evaluation and management
About 99304: Initial nursing facility care, straightforward or low complexity
Report this initial nursing facility evaluation when the documented medical decision making is straightforward or low complexity, or the service meets the 25-minute time threshold.
Code 99304 describes an initial evaluation and management service for a patient in a nursing facility, such as a skilled nursing facility or nursing home. A physician or other qualified health care professional assesses the patient’s condition and needs in that setting and establishes or updates the care plan. The patient may be new or established to the practitioner; the relevant distinction is that the service is initial nursing facility care, not a later follow-up visit.
Select this level when medical decision making is straightforward or low complexity, or when the practitioner’s total time on the date of service meets or exceeds 25 minutes. Document the medically appropriate history and examination, the problems addressed, the data reviewed or analyzed, and the management decisions; when selecting by time, document the qualifying time. CMS assigns work, practice-expense, and malpractice RVUs, with separate practice-expense values for office and facility settings. The listed CMS rules do not specify an add-on, global-period, component, or reduction rule for this code.
Where the value comes from
- Work RVU1.50 · 62%
- Practice expense (office) RVU0.84 · 35%
- Malpractice RVU0.09 · 4%
342.1K
Medicare services in 2024 · #285 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.
99304 compared with similar codes
Office rates for Missouri, from the same CMS release.
$183.41–$189.79
99306 is the high-complexity initial nursing facility level. Use 99304 when the initial service supports straightforward or low-complexity decision making or meets its time threshold.
$39.69–$41.27
99307 is for subsequent nursing facility care, not the initial nursing facility service. The sequence of care in the facility distinguishes it from 99304.
Compare 99304 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.
3 of 3 payment localities
Metropolitan Kansas City →
Office / nonfacility
$79.38
Facility
$69.97
Metropolitan St. Louis →
Office / nonfacility
$79.82
Facility
$70.28
Rest Of Missouri →
Office / nonfacility
$77.21
Facility
$68.58
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99304 billing questions
When should 99304 be chosen over 99305?
Use 99304 for an initial nursing facility service when medical decision making is straightforward or low complexity, or when selecting by time at the 25-minute threshold. Use 99305 when the documented medical decision making is moderate complexity or the applicable time threshold is met.
Does the patient have to be new to the practitioner?
No. The code is for initial nursing facility care and is not determined by whether the patient has previously seen that practitioner.
Can the level be selected by time?
Yes. The practitioner’s total time on the date of service must meet or exceed 25 minutes. Document the qualifying time and the work performed.
How does 99304 differ from a subsequent nursing facility visit?
99304 represents initial nursing facility care. For a later follow-up service in the facility, select the applicable subsequent nursing facility care level, such as 99307 or 99308.
What documentation supports 99304?
Document the clinical issues evaluated, the medically appropriate history and examination, and the reasoning behind the straightforward or low-complexity decisions. If selecting by time, document the total qualifying time on the date of service.
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.
13,04299288,,Direct advanced life support,B,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
13,04399291,,Critical care first hour,A,,4.50,4.29,,1.00,,0.46,9.25,5.96,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,04499292,,Critical care addl 30 min,A,,2.25,1.53,,0.52,,0.23,4.01,3.00,0,ZZZ,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,04599304,,1st nf care sf/low mdm 25,A,,1.50,0.84,,0.54,,0.09,2.43,2.13,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,04699305,,1st nf care moderate mdm 35,A,,2.50,1.54,,0.91,,0.18,4.22,3.59,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,04799306,,1st nf care high mdm 50,A,,3.50,2.05,,1.16,,0.23,5.78,4.89,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,04899307,,Sbsq nf care sf mdm 10,A,,0.70,0.51,,0.36,,0.05,1.26,1.11,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00