$159.24
99310 requires high MDM or at least 45 minutes of practitioner time. Use 99309 for moderate MDM or when at least 30 minutes supports time-based selection but the 99310 threshold is not met.
On this page
CMS RVU26D · Effective 2026-10-01
99309 Nursing facility visit Medicare reimbursement rates in Vermont
Report a follow-up visit for a skilled nursing or nursing facility resident when the practitioner performs moderate medical decision making or spends at least 30 minutes. Compare 99309 office and facility rates across CMS payment localities in Vermont.
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 99309 in Vermont?
Vermont 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
$111.80
1 of 1 localities have a supported rate.
Payment area: Vermont
One mapped payment locality.
Facility setting
$95.93
1 of 1 localities have a supported rate.
Payment area: Vermont
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 99309: Subsequent nursing facility visit, moderate complexity
Report a follow-up visit for a skilled nursing or nursing facility resident when the practitioner performs moderate medical decision making or spends at least 30 minutes.
This follow-up visit addresses a resident in a skilled nursing facility or nursing facility. A typical moderate-MDM encounter involves worsening heart failure requiring a diuretic change, or management of two stable chronic conditions with prescription medications. Attending physicians, nurse practitioners, and physician assistants perform these visits during post-acute or long-term care rounds. The visit may include assessing changes in condition, reviewing facility records, discussing care with nursing staff, and updating treatment orders.
Select the level by medical decision making (MDM) or the reporting practitioner's total time on the encounter date. Time-based selection requires at least 30 minutes and can include chart review, discussions with nurses or family, orders, and documentation; exclude staff time and time spent on separately reported services. For MDM-based selection, at least two of three elements must reach the moderate level: problems addressed, data reviewed or ordered, and management risk. Document the clinical changes, treatment decisions, or time supporting the chosen level. Report the correct place of service: skilled nursing facility (POS 31) uses facility practice expense inputs, while nursing facility (POS 32) uses nonfacility inputs.
Where the value comes from
- Work RVU1.92 · 56%
- Practice expense (office) RVU1.37 · 40%
- Malpractice RVU0.14 · 4%
14.9M
Medicare services in 2024 · #13 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.
99309 compared with similar codes
Office rates for Vermont, from the same CMS release.
$137.47
99305 is an initial nursing facility visit at moderate MDM or at least 35 minutes. 99309 is for a subsequent visit at moderate MDM or at least 30 minutes.
$129.17
99349 is a moderate-level established patient home or residence visit, including visits in assisted living. 99309 is for subsequent visits in skilled nursing facilities or nursing facilities.
$77.18
99308 requires low MDM or at least 20 minutes. For 99309, at least two MDM elements must reach moderate complexity, or practitioner time must reach 30 minutes.
Compare 99309 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
Vermont →
Office / nonfacility
$111.80
Facility
$95.93
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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 99309 in Vermont.
PPRRVU2026_Oct_nonQPP.csv
13,050
- Code
- 99309
- Physician work
- 1.92
- Practice expense
- 1.37
- Malpractice
- 0.14
GPCI2026.csv
105
- Locality
- Vermont
- Physician work
- 1.000
- Practice expense
- 0.990
- Malpractice
- 0.506
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.92 | × 1.000 | 1.9200 |
| Practice expense | 1.37 | × 0.990 | 1.3563 |
| Malpractice | 0.14 | × 0.506 | 0.0708 |
| Total RVUs | 3.3471 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Vermont$111.80
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.92 | 1 |
| Practice expense | 1.37 | 0.99 |
| Malpractice | 0.14 | 0.506 |
(1.92 × 1 + 1.37 × 0.99 + 0.14 × 0.506) × $33.4009 = $111.80
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.92 | 1 |
| Practice expense | 0.89 | 0.99 |
| Malpractice | 0.14 | 0.506 |
(1.92 × 1 + 0.89 × 0.99 + 0.14 × 0.506) × $33.4009 = $95.93
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.
99309 billing questions
When does a visit qualify as 99309 instead of 99308?
Choose 99309 when at least two MDM elements reach the moderate level or the reporting practitioner spends at least 30 minutes on the encounter date. Choose 99308 for low MDM or when at least 20 minutes supports time-based selection but the 99309 threshold is not met.
What counts toward the 30 minutes?
Count the reporting physician's or qualified health care professional's time on the encounter date, including the visit, record review, discussions with nurses or family, orders, and documentation. Exclude facility staff time, time on other dates, and time spent on separately reported services.
Can 99309 be reported for an assisted living resident?
No. Assisted living is a home or residence setting; select the appropriate home or residence E/M code based on the patient's status, MDM, or time. Nursing facility visit codes are for skilled nursing facilities and nursing facilities.
Can 99309 be reported on the same day as the discharge visit?
The practitioner reporting nursing facility discharge management uses 99315 or 99316 for work performed on the discharge date rather than also reporting a subsequent nursing facility visit for that work.
Is 99309 used for the first visit after a resident's readmission?
If the practitioner performs the initial nursing facility assessment for the readmission, select an initial visit code from 99304–99306. Use 99307–99310 for subsequent visits.
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.
13,04799306,,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
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
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
10802402,WA,02,SEATTLE (KING CNTY),1.050,1.227,0.817