CPT code 99347: Home visit, established patient, straightforward medical decision-making

Become informed of the documentation requirements and billing guidelines of CPT code 99347 with our short guide.

What is the 99347 CPT code?

CPT code 99347 is used for a home visit involving the evaluation and management of an established patient. This service includes a problem-focused history, a problem-focused examination, and straightforward medical decision-making.

It typically applies when a healthcare provider sees a patient in their home to address a stable or minor condition that does not require complex decision-making or extensive evaluation. This home or residence services code is specifically for established patients and reflects a lower level of medical complexity during the visit.

This service includes history-taking, a relevant physical exam, and a care plan addressing one or more stable conditions.

CPT code 99347 documentation requirements

To demonstrate medical necessity and avoid any potential issues with payers, the document for CPT code 99347 must have or prove the following:

Established patient status
Chief complaint and relevant, problem-focused history
Physical examination and review of systems
Straightforward medical decision making
Assessment, plan, and any orders or education provided
If time is a determining factor for the code level (at least 20 minutes), the start and end should be documented

The record must demonstrate patient interaction and clinical decision-making aligned with low complexity criteria.

CPT code 99347 billing guidelines

For accurate medical billing and proper reimbursement, the guidelines below must be considered:

Report only for established patients (seen by the provider or same group in the past 3 years).
Only one home E/M per provider per day may be billed; preferably, only the physician or other qualified health care professional who provided the service should bill the code
Used the appropriate place of service (POS) codes and modifiers

Other relevant CPT codes

99348: Low complexity home visit, 30 minutes
99349: Moderate complexity home visit, 40 minutes
99341–99345: New patient home visits

Frequently asked questions

As of 2020, it can be. However, it is preferable for in-person home services.

Yes, if the patient resides there and the service is rendered face-to-face.

Yes, CPT code 99347 may be used when providing evaluation and management services to established patients in settings such as a private residence, rest home, assisted living facility, or similar non-hospital residences. However, it's important to note that this code applies only when the visit includes a problem-focused history, problem-focused examination, and straightforward medical decision-making.

It does not cover custodial care services and is strictly for medical management services provided by a qualified healthcare professional.