Reimbursement
$103.21
Threshold
40m
2026 Status
Active
What is CPT Code 99349?
CPT 99349 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 moderate level medical decision making. Typically, 40 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
1.7
Physician Effort
PE (Non-Fac)
1.25
Practice Expense
Malpractice
0.14
Risk Factor
Total RVU
3.09
Note: [(Work RVU * Work GPCI) + (PE RVU * PE GPCI) + (MP RVU * MP GPCI)] * Conversion Factor
2026 CMS Policy Intelligence
work intensity recognition
wRVU of 1.7 correctly captures the complexity of home-based moderate management.
efficiency shield
Exempt from -2.5% efficiency cut.
remote longitudinal link
99349 often serves as the face-to-face anchor for high-intensity CCM or BHI programs.
Administrative Framework
Global Period
000
Place of Service
NCCI Exclusions
Operational Requirements
minimum time
40 minutes (if billing by time)
staff type
Physician or other Qualified Health Care Professional (QHP)
frequency
As clinically necessary
add on codes
care plan requirement
Moderate MDM involving management of 2+ stable chronic conditions or 1 acute worsening with systemic symptoms.
Compliance Checklist
Audit Defense
No specific audit defense elements defined.
2026 Update
Payers are increasingly looking for 'Patient Mobility' documentation as a secondary factor in justifying high-level Home E/M.
Common Clinical Scenarios
CMS Eligibility: 2+ stable chronic conditions or 1 acute problem with systemic symptoms. Longitudinal follow-up
Target Specialties & Utilization
Typical Clinical Indications (ICD-10)
Billing Differentiation
VS 99348
99348 is for low-to-moderate MDM (30m); 99349 is for moderate MDM (40m) with significantly higher total RVU.
VS 99350
99350 is for high MDM (60m).
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