Reimbursement
$153.31
Threshold
60m
2026 Status
Active
What is CPT Code 99344?
CPT 99344 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 high level medical decision making. Typically, 60 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
3
Physician Effort
PE (Non-Fac)
1.45
Practice Expense
Malpractice
0.14
Risk Factor
Total RVU
4.59
Note: [(Work RVU * Work GPCI) + (PE RVU * PE GPCI) + (MP RVU * MP GPCI)] * Conversion Factor
2026 CMS Policy Intelligence
aging in place valuation
wRVU of 3.0 rewards the intense cognitive effort required to manage multiple systemic issues in a home setting.
efficiency shield
Exempt from -2.5% efficiency cut.
prolonged service alignment
Pairs with 99417 (or G2212 for Medicare) for visits lasting more than 75 minutes.
Administrative Framework
Global Period
000
Place of Service
NCCI Exclusions
Operational Requirements
minimum time
60 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
99417 (Prolonged services - if time exceeds 75 minutes)
care plan requirement
High MDM involving extensive review of stable chronic conditions or acute severe problems.
Compliance Checklist
Audit Defense
No specific audit defense elements defined.
2026 Update
Medicare is auditing high-level Home E/M to ensure 'face-to-face' time is explicitly separated from 'administrative' time in the home.
Common Clinical Scenarios
CMS Eligibility: Multiple unstable chronic conditions or 1 severe acute illness. Initial engagement for high-risk patient
Target Specialties & Utilization
Typical Clinical Indications (ICD-10)
Billing Differentiation
VS 99342
99342 is moderate MDM (30m); 99344 is high MDM (60m).
VS 99345
99345 is the highest tier (75m).
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