CPT code 99305: Initial nursing facility care, moderate complexity

Know more about CPT code 99305, its documentation requirements, and billing guidelines for accurate coding in our short guide.

Use Code

What is the 99305 CPT code?

CPT code 99305 is used for initial comprehensive evaluation and management in a nursing facility for patients requiring moderate complexity medical decision making.

It is typically used for patients in a nursing facility who will require a comprehensive assessment and management plan. More specifically, healthcare providers who will use this code must take a comprehensive history, comprehensive examination, and make a medical decision of moderate complexity during the first visit after admission to a skilled nursing facility or nursing facility.

Do note that this code can be used for both new or established patients.

CPT code 99305 documentation requirements

To avoid claim denials and audit risks, accurate documentation for CPT code 99305 is needed. Which means, the records must contain the following:

Comprehensive history (i.e. reason for admission, extended history of present illness/health conditions, ROS, etc.)
Comprehensive assessment or examination (i.e full physical examination)
Moderate-complexity MDM: multiple problems, medication management, necessary interventions, care coordination, etc.
If time is the determinant for selecting the evaluation and management services level, the typical time is 35 minutes and the time spent must be documented, meeting or exceeding the typical time.

Do note that face-to-face interaction is required.

CPT code 99305 billing guidelines

To streamline claims processing and minimize claim denials, one must follow the billing guidelines mentioned below.

Report once per admission, per physician/admitting provider/qualified professional.
Only one initial nursing facility care code (99304, 99305, or 99306) may be billed per patient admission. Do not submit 99305 if 99304 or 99306 has already been billed for the same encounter.

Use the appropriate modifier(s) when billing situations require them, such as when services are shared or provided under special circumstances. Modifiers ensure accurate claims processing and proper reimbursement.