Reimbursement
$210.09
Threshold
75m
2026 Status
Active
What is CPT Code 99345?
CPT 99345 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 of medical decision making OR 75 minutes of total time on the date of the encounter. This code is for patients being seen for the first time by the physician or practice in their home or residence.
This code is primarily used for E/M services. It falls under the category of Evaluation and Management / Home Services 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
3.3
Physician Effort
PE (Non-Fac)
2.85
Practice Expense
Malpractice
0.14
Risk Factor
Total RVU
6.29
Note: [(Work RVU * Work GPCI) + (PE RVU * PE GPCI) + (MP RVU * MP GPCI)] * Conversion Factor
2026 CMS Policy Intelligence
valuation surge
8.5% increase reflects updated PE inputs for equipment and travel, supporting the 'aging in place' strategy.
g2211 applicability
CMS finalized the use of G2211 for home visits in 2026, adding ~$16.00 for longitudinal complexity.
diversion strategy
Higher reimbursement incentivizes home-based management to reduce ER visits and hospitalizations.
Administrative Framework
Place of Service
NCCI Exclusions
Key Modifiers
Operational Requirements
minimum time
75 minutes (if using time for selection)
staff type
MD, DO, NP, PA
frequency
Once per lifetime for 'New Patient' definition within a practice.
add on codes
G2211, 99417 (Prolonged services for home E/M)
homebound status
Not required for Physician Home Visits (distinguishes from Home Health Benefit), but reason for home site must be documented.
Compliance Checklist
Audit Defense
No specific audit defense elements defined.
2026 Update
The combination of 99345 and G2211 makes home visits financially competitive with office-based specialized care.
Common Clinical Scenarios
CMS Eligibility: Requires High Level of Medical Decision Making (MDM).. New Patient (no services from practice in 3 years).
Target Specialties & Utilization
Typical Clinical Indications (ICD-10)
Billing Differentiation
VS 99350
99350 is for an Established patient; 99345 is for a New patient.
VS Office
Higher payment than office level 5 (99205) to account for travel and practice expense of home equipment.
Frequently Asked Questions
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