CPT code 99304: Initial nursing facility care, low complexity

Learn more about how to use CPT code 99304 through our guide that comes complete with documentation requirements and billing guidelines.

Use Code

What is the 99304 CPT code?

CPT code 99304, developed and managed by the American Medical Association, refers to the initial comprehensive assessment or evaluation and management of healthcare providers in a skilled nursing facility or nursing facility when low-complexity medical decision-making is involved. The nursing facility services offered in this code include gathering a detailed history, conducting a comprehensive assessment, etc.

CPT code 99304 documentation requirements

In order for the document to clearly support the level of service, it must have the following:

Detailed or comprehensive history and physical examination
Proof of straightforward or low complexity medical decision making
Proof of time spent on the encounter if time is used as the determining factor
Reason for admission, care goals, and follow-up plans
A clear justification of medical necessity

CPT code 99304 billing guidelines

To ensure that the nursing facility billing and reimbursement goes smoothly, the following guidelines must be kept in mind when using the code:

Use for initial nursing home admissions with low MDM complexity.
Billable once per stay per provider.
Cannot be billed with 99305 or 99306 for the same admission.
Use place of service (POS) 31 or 32, depending on the facility type.
Can be used for new or established patients

Ensure subsequent or follow-up visits use appropriate follow-up codes.

Other relevant CPT codes

99305: Initial visit, moderate complexity
99306: Initial visit, high complexity
99307–99310: Subsequent care codes

Frequently asked questions

Yes, if no active issues require moderate or high-complexity MDM.

Not necessarily. CPT 99304 is primarily selected based on the complexity of medical decision-making, but if billed based on time, it typically represents 25 minutes of total time spent on the date of the encounter.

Any physician or qualified healthcare professional (QHP) who performs and documents the initial comprehensive assessment and is responsible for patient management, such as developing a care plan upon admission, may bill this code.