CPT code 99350: Home visit for established patient, high complexity

What is the 99350 CPT code?

CPT code 99350 is used to report an established patient encounter during a home or residence visit that involves a high level of medical decision-making or when the total time spent on the encounter on a single date is 60 minutes or more.

This code falls under the Evaluation and Management (E/M) category and is specifically for services provided in a patient's home or other residential setting (including assisted living facilities, group homes, custodial care facilities, and residential substance abuse treatment facilities).

Furthermore, the code includes patients with multiple or unstable conditions, complex medication management, or a high risk of morbidity. The visit must be medically necessary and not for convenience.

Healthcare providers commonly use this code in geriatrics, palliative care, or complex chronic disease management at home.

Documentation requirements

To appropriately bill CPT code 99350, a healthcare provider documentation must clearly support the level of service reported. This includes:

• Comprehensive history and examination (as appropriate)
• High-complexity medical decision making
• Duration of visit if it's based on time
• Home setting and reason for visit
• Details that support medical necessity of home or residence services

Billing guidelines

When billing CPT code 99350, adhere to the following guidelines:

• Only used for established patients
• Only used for the appropriate place of service
• The total encounter time meets or exceeds 60 minutes
• Services provided meet medical necessity criteria
• Modifiers are used of needed
• Other codes are used for prolonged services