CPT Code 99310: Subsequent Nursing Facility Care, High Complexity

Learn how to report CPT code 99310 for high-complexity nursing facility care, including billing tips and documentation standards.

Use Code

What is CPT code 99310?

Code 99310 is part of the Current Procedural Terminology (CPT) code set, which the American Medical Association maintains. Healthcare providers use it to report subsequent nursing facility care for an established patient that involves high-complexity medical decision making or services that require 35 minutes or more of time spent at the bedside and on the patient’s nursing home unit.

This code is not used for the initial visit; instead, it is appropriate for follow-up care after the initial comprehensive assessment (typically reported with CPT codes 99304–99306). CPT 99310 reflects intensive, ongoing care for patients with complex or unstable medical conditions that require close monitoring, treatment adjustments, and coordination across disciplines.

Documentation requirements

Accurate and detailed documentation is essential to support medical necessity, particularly when billing higher-level services, such as CPT 99310, in nursing facility settings. The following elements should be included in the medical record:

High-complexity medical decision making

The visit must involve high-complexity MDM, including:

Managing multiple chronic conditions or serious acute illness
Interpreting extensive data (labs, diagnostics, specialist input)
Adjusting treatment in response to significant changes in condition
High risk of complications, functional decline, or mortality

This level of decision-making should be evident through clear clinical reasoning and supporting documentation.

Time spent (for time-based billing)

When billing based on time, the healthcare provider must spend at least 45 minutes in face-to-face care, including bedside evaluation and interaction with the care team on the nursing facility floor or unit. Record the total time spent or document clear start and stop times.

Established patient status

CPT 99310 applies only to established patients in a nursing home or long-term care setting. Documentation should confirm that this is not the patient’s initial visit and that the provider is continuing ongoing management.

Billing guidelines

When billing CPT 99310, providers must comply with CPT coding principles and payer-specific rules, including those from Medicaid services, Medicare, and commercial plans.

Use only when medically necessary

CPT 99310 should be used only when justified by medical necessity. It is not appropriate for routine daily visits or patients with stable conditions. Use lower-level codes (99307–99309) for less complex follow-ups.

Cannot be combined with same-day E/M services

This code cannot be billed on the same day as other evaluation and management (E/M) services, including outpatient or hospital visits, unless the services are separate and supported by documentation. Use modifiers (e.g., -25) as needed to identify distinct services.

Setting-specific use

CPT 99310 is used only in nursing facility settings, such as skilled nursing facilities (SNFs), intermediate care facilities, or long-term care facilities. It does not apply to outpatient, inpatient hospital, or home care settings.

Qualified provider requirements

Only qualified healthcare providers, such as physicians, nurse practitioners, and physician assistants, who are authorized to perform and bill for E/M services, may report CPT 99310. Providers must adhere to scope-of-practice rules and Medicaid services policies where applicable.

Other related codes

99304–99306 – Initial nursing facility care (based on complexity and time for new admissions)
99307 – ubsequent nursing facility care, stable or improving condition (low complexity)
99308 – Subsequent nursing facility care, moderate complexity

Frequently asked questions

CPT 99310 is used for subsequent nursing facility care involving high-complexity medical decision-making or when the provider spends 45 minutes or more with the patient on the facility floor. It applies to established patients in settings like skilled nursing facilities.

No. Routine or low-complexity visits should be billed using lower-level codes, such as 99307, 99308, or 99309, depending on the level of care complexity. CPT 99310 should only be used when medical necessity supports it.

Generally, no. CPT 99310 should not be billed on the same day as other E/M codes unless the services are separate and distinct, and documentation justifies both. Use modifiers (e.g., -25) if allowed by the payer.