Reimbursement
$44.42
Threshold
20m
2026 Status
Active
What is CPT Code 99347?
CPT 99347 is defined as: Home or residence visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. Typically, the presenting problem(s) are of low severity.
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
0.57
Physician Effort
PE (Non-Fac)
0.71
Practice Expense
Malpractice
0.05
Risk Factor
Total RVU
1.33
Note: [(Work RVU * Work GPCI) + (PE RVU * PE GPCI) + (MP RVU * MP GPCI)] * Conversion Factor
2026 CMS Policy Intelligence
continuity support
Recognizes the value of routine professional contact for home-bound patients to prevent ER readmissions.
efficiency shield
Exempt from -2.5% efficiency cut.
site unification
Covers both home and domiciliary settings under the 99347-99350 set.
Administrative Framework
Global Period
000
Place of Service
NCCI Exclusions
Operational Requirements
minimum time
Not time-based (based on MDM)
staff type
Physician or other Qualified Health Care Professional (QHP)
frequency
As clinically necessary for established patients
add on codes
care plan requirement
Documentation of ongoing stability or minor acute issues in the home setting.
Compliance Checklist
Audit Defense
No specific audit defense elements defined.
2026 Update
Many payers now require a 'Clinical Justification for Home Setting' to be documented quarterly for high-frequency users.
Common Clinical Scenarios
CMS Eligibility: 1 or more stable chronic conditions or self-limited injury. Longitudinal follow-up
Target Specialties & Utilization
Typical Clinical Indications (ICD-10)
Billing Differentiation
VS 99341
99341 is for a new patient; 99347 is for an ESTABLISHED patient.
VS 99348
99348 involves moderate MDM (20m).
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