CPT Code 99342: Home Visit, New Patient, Low Complexity

CPT code 99342 documentation requirements

For accurate coding and reimbursement, the documentation for CPT code 99342 should include the following elements:

• Expanded problem-focused history
• Expanded problem-focused examination
• Proof of new patient designation (not seen by the provider in the past 3 years)
• Low complexity MDM: only minimal health care decision making, limited problems, limited data, and low risk
• Reflection of the total time spent, if time is used for code selection
• Proof of medical necessity for a home visit for the evaluation and management
• Assessment and care plan

CPT code 99342 billing guidelines

Ensuring proper reimbursement and compliance with CPT code 99324 means adhering to the following billing guidelines:

• Must use appropriate POS codes -- in this case, it's POS 12, which reflects home setting
• Must use appropriate modifiers to provide additional information about the service
• Use for new patient home E/M visits with low complexity
• The home visit must be medically reasonable
• Generally, one E/M service per patient per day by only the physician who provided the service
• Be mindful to report prolonged services with the correct codes when appropriate
• Review provider contracts as reimbursement rates will vary based on the payer type

Other relevant CPT codes

• 99341: Home visit, straightforward medical decision making
• 99344–99345: Higher complexity new patient home visits
• 99347–99350: Established patient home visits