Billing code 99342: Home visitMedicare rate & RVUs in Virginia
A new-patient home or residence evaluation with low-complexity medical decision making, reported when the visit meets low MDM or at least 30 minutes.
Medicare pays $77.78–$85.87 for 99342 in the office in Virginia, from Virginia to Dc + Md/Va Suburbs. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 9 sections
What 99342 covers
99342 is for an E/M encounter with a new patient in a private home or another residence, such as an assisted living residence or group home. A physician or qualified health care professional assesses the patient’s concerns, relevant history and examination findings, and develops or updates a plan. The code fits low-level decision making, such as management of stable chronic conditions or an uncomplicated acute concern, when the documented work supports that level. The patient must not have received professional services from the same physician or another clinician of the same specialty and group within the prior three years.
Select 99342 by low medical decision making or by the physician’s or qualified health care professional’s total time on the date of service; time-based reporting requires at least 30 minutes. Document the residence, the problems addressed, information reviewed, management risk, and time when used to select the level. A home visit alone does not establish this code: straightforward MDM supports a lower level, while moderate or high MDM points to a higher new-patient home/residence level. CMS assigns work, practice-expense, and malpractice relative values to this service in the physician fee schedule.
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.
Where 99342 pays more and less in Virginia
| Payment locality | Office | Facility |
|---|---|---|
| Dc + Md/Va Suburbs | $85.87 | Unavailable |
| Virginia | $77.78 | Unavailable |
How the 99342 rate is calculated
Each of 99342’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 99342
RVUs × geographic indexes × conversion factor
Work1.65
1.65 RVUs× 1.000 GPCI
Practice expense0.64
0.64 RVUs× 1.000 GPCI
Malpractice0.07
0.07 RVUs× 1.000 GPCI
Adjusted RVUs
2.3600
Conversion factor
$33.4009
Medicare rate
$78.83
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 99342
99342 has no global surgery period, no multiple-procedure, bilateral or assistant-at-surgery adjustment, and no professional/technical split. What changes the payment is where the service happens: the place of service on the claim decides whether Medicare pays the office or the facility rate.
Place of service · 99342
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
POS 11 · non-facility rate · national
$78.83
Higher because the practice carries its own overhead.
99342 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 99341Home visit
- Both are new-patient home or residence visits. Choose 99341 for straightforward MDM; 99342 requires low MDM or at least 30 minutes when selected by time.
- 99344Home visit
- Both are new-patient home or residence visits. 99344 represents moderate MDM or a higher time threshold; 99342 represents low MDM or at least 30 minutes.
- 99348Home visit
- Both describe low-MDM home or residence visits, but 99348 is for an established patient and 99342 is for a new patient.
- 99306Nursing facility visit
- 99306 is for an initial nursing facility service at high MDM. Use the home or residence visit family when the encounter is furnished in a patient’s home or other residence.
99342 billing questions
How does 99342 differ from 99348?
99342 is for a new patient; 99348 is for an established patient. Both are home or residence visits at the low MDM level, so patient status distinguishes them.
Can time determine the level?
Yes. Report 99342 when total physician or qualified health care professional time on the date of service reaches at least 30 minutes, if using time to select the code.
What supports reporting 99342?
Document the residence, new-patient status, problems evaluated, information considered, and management risk. If selecting the code by time, document the qualifying total time for that date.
Is a home visit alone enough for 99342?
No. The encounter must be in a home or residence, involve a new patient, and support low MDM or the required time. A straightforward encounter may support a lower level.
Should 99342 be used for a nursing facility visit?
No. 99342 is for home or residence E/M services. Nursing facility services use the nursing facility E/M code family; 99306, for example, describes an initial nursing facility service at high MDM.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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