$111.34
99309 describes moderate MDM or at least 30 minutes when the higher level is not met; 99310 requires high MDM or at least 45 minutes of qualifying time.
On this page
CMS RVU26D · Effective 2026-10-01
99310 Nursing facility visit Medicare reimbursement rates in Utah
Follow-up nursing facility or skilled nursing facility visit for a resident whose care requires high-complexity medical decision making or at least 45 minutes of practitioner time. Compare 99310 office and facility rates across CMS payment localities in Utah.
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 99310 in Utah?
Utah 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.
Office / nonfacility
$158.85
1 of 1 localities have a supported rate.
Payment area: Utah
One mapped payment locality.
Facility setting
$137.18
1 of 1 localities have a supported rate.
Payment area: Utah
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
About 99310: Subsequent nursing facility visit, high complexity
Follow-up nursing facility or skilled nursing facility visit for a resident whose care requires high-complexity medical decision making or at least 45 minutes of practitioner time.
This is the highest level in the subsequent nursing facility E/M series. It covers a follow-up visit to a skilled nursing facility or long-term nursing facility resident after the initial evaluation. A practitioner might assess suspected sepsis, new respiratory failure, or a severe heart failure or COPD exacerbation and decide whether hospital transfer or a major change in treatment is needed. Attending physicians, geriatricians, nurse practitioners, and physician assistants commonly provide these visits during facility rounds.
Select 99310 when medical decision making is high or the reporting practitioner's qualifying time on the date of service reaches 45 minutes. High MDM requires two of three elements—problems, data, and management risk—at the high level; a hospitalization decision alone does not establish the overall level. Time may include examining the resident, reviewing records, coordinating with facility staff, and documenting, but excludes staff time and work counted toward another reported service. Document the supporting MDM elements or total qualifying time. If the visit is selected by time and Medicare's prolonged-service threshold is met, G0317 may be reported for eligible additional time.
Where the value comes from
- Work RVU2.80 · 57%
- Practice expense (office) RVU1.88 · 38%
- Malpractice RVU0.21 · 4%
2.2M
Medicare services in 2024 · #75 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.
99310 compared with similar codes
Office rates for Utah, from the same CMS release.
$188.17
99306 describes an initial nursing facility evaluation at high MDM; 99310 describes a subsequent nursing facility visit.
$188.35
99350 applies to established patients seen at home or in assisted living and similar residences; 99310 applies to residents in a skilled nursing facility or nursing facility.
$83.57
99315 covers nursing facility discharge management of 30 minutes or less. Choose it instead of 99310 when the service furnished is discharge management.
Compare 99310 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.
1 of 1 payment localities
Utah →
Office / nonfacility
$158.85
Facility
$137.18
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How this local rate is calculated
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 99310 in Utah.
PPRRVU2026_Oct_nonQPP.csv
13,051
- Code
- 99310
- Physician work
- 2.80
- Practice expense
- 1.88
- Malpractice
- 0.21
GPCI2026.csv
104
- Locality
- Utah
- Physician work
- 1.000
- Practice expense
- 0.940
- Malpractice
- 0.898
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 2.80 | × 1.000 | 2.8000 |
| Practice expense | 1.88 | × 0.940 | 1.7672 |
| Malpractice | 0.21 | × 0.898 | 0.1886 |
| Total RVUs | 4.7558 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Utah$158.85
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.8 | 1 |
| Practice expense | 1.88 | 0.94 |
| Malpractice | 0.21 | 0.898 |
(2.8 × 1 + 1.88 × 0.94 + 0.21 × 0.898) × $33.4009 = $158.85
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.8 | 1 |
| Practice expense | 1.19 | 0.94 |
| Malpractice | 0.21 | 0.898 |
(2.8 × 1 + 1.19 × 0.94 + 0.21 × 0.898) × $33.4009 = $137.18
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.
99310 billing questions
How do I decide between 99309 and 99310?
Use 99310 for high MDM or at least 45 minutes of qualifying time. Use 99309 for moderate MDM or at least 30 minutes when 99310's criteria are not met; a hospitalization decision can support high management risk but does not, by itself, establish high MDM.
Can 99310 be reported for a resident's first visit by our group?
Choose the code based on the service performed, not simply whether the resident is new to the group. Initial nursing facility codes 99304-99306 describe an initial evaluation; 99310 describes subsequent care.
What counts toward the 45 minutes?
Count the reporting practitioner's qualifying work on the date of service, such as examining the resident, reviewing records, coordinating care, ordering, and documenting. Exclude facility staff time and time spent on separately reported services.
How is prolonged time billed for Medicare with 99310?
When 99310 is selected by time and Medicare's threshold for prolonged nursing facility care is met, report G0317 for eligible additional 15-minute increments rather than CPT 99418. Document the total qualifying time.
Which place of service is used?
Use POS 31 for a skilled nursing facility stay and POS 32 for a nursing facility. Visits to assisted living residents fall under home or residence visit codes instead.
Can I bill 99310 and a discharge code for the same service?
No. When the service is nursing facility discharge management, report 99315 or 99316 according to the time spent on that service instead of 99310.
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.
13,04899307,,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
13,04999308,,Sbsq nf care low mdm 20,A,,1.30,0.98,,0.65,,0.08,2.36,2.03,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,05099309,,Sbsq nf care moderate mdm 30,A,,1.92,1.37,,0.89,,0.14,3.43,2.95,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,05199310,,Sbsq nf care high mdm 45,A,,2.80,1.88,,1.19,,0.21,4.89,4.20,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,05299315,,Nf dschrg mgmt 30 min/less,A,,1.50,0.98,,0.60,,0.09,2.57,2.19,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,05399316,,Nf dschrg mgmt 30 min+,A,,2.50,1.47,,0.85,,0.17,4.14,3.52,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,05499341,,Home/res vst new sf mdm 15,A,,1.00,0.43,,0.43,NA,0.04,1.47,1.47,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
10104412,TX,15,GALVESTON,1.008,0.993,0.828
10204412,TX,18,HOUSTON,1.008,0.993,1.376
10304412,TX,99,REST OF TEXAS,1.000,0.949,0.903
10403502,UT,09,UTAH,1.000,0.940,0.898
10514512,VT,50,VERMONT,1.000,0.990,0.506
10611302,VA,00,VIRGINIA,1.000,0.983,0.706
10709202,VI,50,VIRGIN ISLANDS,1.000,1.011,0.985