CPT Code 99345: Home Visit, New Patient, High Complexity

Bill CPT code 99345 correctly for high-complexity home visits. Learn documentation requirements and reimbursement guidance.

Use Code

What is CPT code 99345?

CPT code 99345 is used to report evaluation and management (E/M) services for a new patient receiving home or residence services, specifically a face-to-face visit involving high-complexity medical decision-making or 75 minutes or more of provider time. It applies to patients with significant medical needs that require thorough assessment and intervention in a private residence. This code falls under the Home or Residence Services category and may be reported in combination with prolonged services codes if the visit exceeds the base time requirement.

The patient must be new to the provider, meaning they have not received face-to-face services from the same physician or group within the past three years. CPT 99345 does not apply to patients in intermediate care facilities, rest homes, assisted living, or temporary lodging arrangements such as hotels or shelters, nor is it appropriate for situations where only minimal health care is delivered. Those scenarios require different E/M codes that reflect the lower complexity or different settings.

Documentation requirements

Complete and accurate documentation is critical to support the medical necessity and complexity of care provided during a home or residence visit under CPT 99345.

New patient criteria

Confirm that the patient is new to the provider or practice. Include relevant medical history, referral information (if applicable), and the reason the patient requires home-based evaluation and management services.

High-complexity medical decision making

CPT 99345 requires documentation of high-complexity MDM, which may involve:

Management of multiple chronic conditions
High risk of complications or mortality
Coordination of prolonged services involving other care providers or community resources
Considerable time spent reviewing diagnostic results or determining an extensive plan of care

Time-based option

This code may alternatively be billed based on total time spent on the date of the encounter, including both face-to-face and non-face-to-face activities. Providers must spend at least 75 minutes, and all time must be documented clearly.

Reason for residence services

Document the rationale for providing care in the patient’s residence, such as mobility limitations, lack of access to in-office care, or the need for ongoing observation due to a significant medical issue. Clarify that the home setting is a private residence, not a rest home or intermediate care facility.

Billing guidelines

CPT 99345 must be billed accurately to comply with payer rules and support reimbursement for home or residence services:

Not for facility use

Do not report 99345 for visits to intermediate care facilities, rest homes, or assisted living centers. For those settings, use appropriate codes.

Use of time vs MDM

You may report the visit based on prolonged services (75+ minutes of provider time) instead of MDM. Make sure time includes only allowable activities like patient counseling, care coordination, and documentation, not administrative tasks or patient wait time.

Coverage verification

Verify coverage with Medicare, Medicaid, and commercial payers for home visits. Some may limit frequency, require prior authorization, or restrict reimbursement to specific types of providers or diagnoses.

Other related CPT codes

99341–99344 – Lower-level home visits for new patients (based on MDM or time)
99347–99350 – Home visits for established patients

Frequently asked questions

No. CPT 99345 is used only for patients receiving care in a private residence.

High-complexity MDM involves managing significant medical risks, multiple active problems, and complex care plans, often requiring coordination with other services or prolonged clinical evaluation.

Yes, if it is related to the patient’s care planning or education and occurs on the same day as the face-to-face encounter.