Reimbursement
$85.50
Threshold
30m
2026 Status
Active
What is CPT Code 99342?
CPT 99342 is defined as: Home or residence visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and low level medical decision making. Typically, 30 minutes must be met if billing by time.
This code is primarily used for E/M services. It falls under the category of Home Evaluation and Management (Home E/M) and is valid for the 2026 calendar year according to the CMS Physician Fee Schedule.
2026 RVU Components
Relative Value Units (Non-Facility)
Work RVU
1.4
Physician Effort
PE (Non-Fac)
1.05
Practice Expense
Malpractice
0.11
Risk Factor
Total RVU
2.56
Note: [(Work RVU * Work GPCI) + (PE RVU * PE GPCI) + (MP RVU * MP GPCI)] * Conversion Factor
2026 CMS Policy Intelligence
home care expansion
Part of the 2026 push to move services out of facilities and into the patient's home.
efficiency shield
Exempt from -2.5% efficiency cut.
residence visit parity
Ensures equal payment regardless of whether 'home' is a private house or an assisted living facility.
Administrative Framework
Global Period
000
Place of Service
NCCI Exclusions
Operational Requirements
minimum time
30 minutes (if billing by time)
staff type
Physician or other Qualified Health Care Professional (QHP)
frequency
Once per new patient per specialty
add on codes
care plan requirement
Low to moderate MDM involving assessment of stable acute or chronic problems.
Compliance Checklist
Audit Defense
No specific audit defense elements defined.
2026 Update
Payers are checking if Home E/M visits lead to increased utilization of CCM/RPM - ensure documentation links these services.
Common Clinical Scenarios
CMS Eligibility: 2+ stable chronic conditions or 1 acute problem with mild systemic symptoms. Initial engagement
Target Specialties & Utilization
Typical Clinical Indications (ICD-10)
Billing Differentiation
VS 99341
99341 is straightforward; 99342 is low MDM (30m).
VS 99344
99344 is moderate-to-high MDM (60m).
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