$141.02
Both are new-patient home or residence visits; 99345 requires high medical decision making or at least 75 minutes, while 99344 represents the lower moderate-complexity level.
On this page
CMS RVU26D · Effective 2026-10-01
99345 Home visit Medicare reimbursement rates in Wisconsin
Report for a new patient’s high-complexity evaluation in a home or residence, supported by high medical decision making or at least 75 minutes. Compare 99345 office and facility rates across CMS payment localities in Wisconsin.
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 99345 in Wisconsin?
Wisconsin 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
$201.28
1 of 1 localities have a supported rate.
Payment area: Wisconsin
One mapped payment locality.
Facility setting
No 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.
Evaluation and management
About 99345: New patient home high-complexity visit
Report for a new patient’s high-complexity evaluation in a home or residence, supported by high medical decision making or at least 75 minutes.
This service covers a comprehensive evaluation and management visit for a new patient seen in a private home or another residence, such as an assisted-living setting. A physician or qualified health care professional may address serious or worsening conditions, review relevant records and test results, and make high-risk treatment decisions. The code is for a patient meeting the CPT new-patient definition for the physician or qualified professional’s specialty and group.
Select this level when medical decision making is high, or when the practitioner’s total qualifying time on the date of service reaches at least 75 minutes. For high medical decision making, the documentation should support the complexity of the problems addressed, the data reviewed or analyzed, and the risk of management decisions. Record the residence, clinical assessment, decisions, and any qualifying time used to select the level. Do not include staff time or time spent on separately reported services in the E/M time total.
Where the value comes from
- Work RVU3.88 · 62%
- Practice expense (office) RVU2.16 · 34%
- Malpractice RVU0.25 · 4%
166.1K
Medicare services in 2024 · #421 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.
99345 compared with similar codes
Office rates for Wisconsin, from the same CMS release.
$184.79
99350 is for an established patient receiving a high-complexity home or residence visit. Use 99345 only when the patient meets the new-patient definition.
$155.84
99310 is a subsequent nursing-facility care code. 99345 is for a new-patient E/M encounter in a home or residence.
Compare 99345 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
Wisconsin →
Office / nonfacility
$201.28
Facility
Unavailable
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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 99345 in Wisconsin.
PPRRVU2026_Oct_nonQPP.csv
13,057
- Code
- 99345
- Physician work
- 3.88
- Practice expense
- 2.16
- Malpractice
- 0.25
GPCI2026.csv
111
- Locality
- Wisconsin
- Physician work
- 1.000
- Practice expense
- 0.958
- Malpractice
- 0.308
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 3.88 | × 1.000 | 3.8800 |
| Practice expense | 2.16 | × 0.958 | 2.0693 |
| Malpractice | 0.25 | × 0.308 | 0.0770 |
| Total RVUs | 6.0263 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Wisconsin$201.28
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 3.88 | 1 |
| Practice expense | 2.16 | 0.958 |
| Malpractice | 0.25 | 0.308 |
(3.88 × 1 + 2.16 × 0.958 + 0.25 × 0.308) × $33.4009 = $201.28
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.
99345 billing questions
When should 99345 be chosen instead of 99344?
Choose 99345 when the encounter supports high medical decision making or at least 75 minutes of qualifying practitioner time. Use 99344 for the lower, moderate-complexity new-patient level.
Does the visit have to meet both high MDM and 75 minutes?
No. The level may be selected by high medical decision making or by meeting the 75-minute time threshold.
Can 99345 be reported for an established patient?
No. For an established patient seen in a home or residence, choose the code in the established-patient series that matches the documented level.
Is a nursing-facility visit reported with 99345?
No. 99345 is for a home or residence visit; nursing-facility E/M services use the nursing-facility code family.
What documentation supports the 75-minute basis?
Document the practitioner’s total qualifying time on the date of service and the work performed. Exclude staff time and time attributable to separately reported 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 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.
13,05499341,,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
13,05599342,,Home/res vst new low mdm 30,A,,1.65,0.64,,0.64,NA,0.07,2.36,2.36,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,05699344,,Home/res vst new mod mdm 60,A,,2.87,1.36,,1.36,NA,0.16,4.39,4.39,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,05799345,,Home/res vst new high mdm 75,A,,3.88,2.16,,2.16,NA,0.25,6.29,6.29,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,05899347,,Home/res vst est sf mdm 20,A,,0.90,0.44,,0.44,NA,0.04,1.38,1.38,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,05999348,,Home/res vst est low mdm 30,A,,1.50,0.79,,0.79,NA,0.07,2.36,2.36,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,06099349,,Home/res vst est mod mdm 40,A,,2.44,1.36,,1.36,NA,0.16,3.96,3.96,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
10802402,WA,02,SEATTLE (KING CNTY),1.050,1.227,0.817
10902402,WA,99,REST OF WASHINGTON,1.013,1.053,0.761
11011402,WV,16,WEST VIRGINIA,1.000,0.869,1.431
11106302,WI,00,WISCONSIN,1.000,0.958,0.308
11203602,WY,21,WYOMING**,1.000,1.000,0.740
113"MAC Assignments as of November 22, 2023",,,,,,
114,,,,,,