Reimbursement
$143.62
Threshold
60m
2026 Status
Active
What is CPT Code 99350?
CPT 99350 is defined as: Home or residence visit for the evaluation and management of a established 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
2.6
Physician Effort
PE (Non-Fac)
1.55
Practice Expense
Malpractice
0.15
Risk Factor
Total RVU
4.3
Note: [(Work RVU * Work GPCI) + (PE RVU * PE GPCI) + (MP RVU * MP GPCI)] * Conversion Factor
2026 CMS Policy Intelligence
palliative transition
Often used in advanced illness management (AIM) or palliative programs to keep patients out of the hospital.
efficiency shield
Exempt from -2.5% efficiency cut.
prolonged service link
Used with 99417 (non-Medicare) or G2212 (Medicare) for encounters exceeding 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
As clinically necessary
add on codes
99417 (Prolonged services - if time exceeds 75 minutes)
care plan requirement
High MDM involving management of multiple chronic unstable conditions or severe life-threatening situations in the home.
Compliance Checklist
Audit Defense
No specific audit defense elements defined.
2026 Update
Payers are correlating 99350 usage with functional status (using Z-codes for ADLs/IADLs) - ensure functional decline is documented.
Common Clinical Scenarios
CMS Eligibility: Multiple complex/unstable conditions or high-risk social/environmental factors. High-intensity follow-up
Target Specialties & Utilization
Typical Clinical Indications (ICD-10)
Billing Differentiation
VS 99349
99349 is moderate MDM (40m); 99350 is high MDM (60m).
VS 99344
99344 is the HIGH level for NEW patients; 99350 is for ESTABLISHED.
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