Billing code 99350: Home visitMedicare rate & RVUs in Washington
Report an established-patient home or residence visit when medical decision making is high or the billing clinician spends at least 60 minutes on the service date.
Medicare pays $196.14–$212.31 for 99350 in the office in Washington, from Rest Of Washington to Seattle (King Cnty). 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 99350 covers
Established patients may be seen in a private home or residential setting, including assisted living, a group home, or a domiciliary or rest home. The separate domiciliary visit series was folded into the home or residence codes in 2023. House-call physicians, nurse practitioners, and physician assistants may evaluate worsening heart failure or COPD and consider escalation to hospital care. A diagnosis or residence alone does not establish high medical decision making.
Select 99350 when the visit supports high medical decision making or the billing physician or qualified health care professional spends at least 60 minutes on the service date. For decision making, document the problems addressed, data reviewed, and management risk; two of these three elements must support the selected level. For time, record the total and work performed, such as same-day record review, counseling, care coordination, and documentation. Exclude travel and time spent on separately billed services. Medicare pays the qualifying visit under the physician fee schedule. If selection is based on time and Medicare’s additional-time threshold is met, G0318 may be reported with 99350. Homebound status is not required.
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 99350 pays more and less in Washington
| Payment locality | Office | Facility |
|---|---|---|
| Rest Of Washington | $196.14 | Unavailable |
| Seattle (King Cnty) | $212.31 | Unavailable |
How the 99350 rate is calculated
Each of 99350’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 · 99350
RVUs × geographic indexes × conversion factor
Work3.60
3.60 RVUs× 1.000 GPCI
Practice expense1.94
1.94 RVUs× 1.000 GPCI
Malpractice0.24
0.24 RVUs× 1.000 GPCI
Adjusted RVUs
5.7800
Conversion factor
$33.4009
Medicare rate
$193.06
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 99350
99350 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 · 99350
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
POS 11 · non-facility rate · national
$193.06
Higher because the practice carries its own overhead.
99350 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 99349Home visit
- 99349 requires moderate medical decision making or at least 40 minutes when 99350 criteria are not met. 99350 requires high medical decision making or at least 60 minutes.
- 99345Home visit
- 99345 is for a new patient: no qualifying professional service from the same specialty and subspecialty in the group within the past three years. 99350 is for an established patient.
- 99215Office visit
- 99215 is an established-patient office or outpatient visit with high medical decision making or at least 40 minutes. Use 99350 for a qualifying home or residence visit with high decision making or at least 60 minutes.
- 99310Nursing facility visit
- 99310 is a high-level subsequent nursing facility visit. 99350 is for an established patient seen in a private home or qualifying residential setting, such as assisted living.
99350 billing questions
When should 99350 be chosen over 99349?
Use 99350 for high medical decision making or at least 60 minutes of qualifying clinician time. Use 99349 for moderate medical decision making or at least 40 minutes when 99350 criteria are not met.
Can this code be reported for a visit in an assisted living facility?
Yes. Home or residence codes cover assisted living, group homes, and domiciliary or rest homes; report the place of service that reflects the actual location. Visits to residents of skilled or long-term nursing facilities use the applicable nursing facility E/M codes instead.
How is prolonged time reported with 99350 for Medicare?
When 99350 is selected by time and Medicare’s prolonged-service threshold is met, report G0318 with 99350 rather than 99417. For non-Medicare claims, 99417 may be used when billing code prolonged-service criteria are met.
Does the patient have to be homebound for Medicare to cover 99350?
No. The homebound requirement for the Medicare home health benefit is not a requirement for a practitioner home visit billed under the physician fee schedule.
What time counts toward the 60-minute threshold?
Count the billing clinician’s qualifying work on the visit date, including record review, counseling, ordering, and care coordination. Do not count travel, staff time, or time spent on separately billed services.
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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