Nursing Home Visit
CPT 99308
A clinician's routine visit to a nursing home resident, checking how they are doing and continuing or adjusting care. Medicare reported 11.8 million services under this code in CY2024.
Plain-language context only — not the official CPT descriptor and not coding guidance
Status A Medicare calculates a national payment amount for this code and pays it separately when the service is covered. Full definition → Nationally priced under PFS, using the RVU formula.
Formula
(work_rvu × work_gpci + pe_rvu × pe_gpci + mp_rvu × mp_gpci) × conversion_factor
Citations
-
Physician relative value file (PPRRVU)
PPRRVU24_OCT.csv
in
rvu24d.zip
(row 18,573)
- hcpcs (col 1)
- 99308
- status_code (col 4)
- A
- work_rvu (col 6)
- 1.3
- pe_rvu_nonfacility (col 7)
- 0.83
- pe_rvu_facility (col 9)
- 0.83
- mp_rvu (col 11)
- 0.09
-
Physician relative value file (PPRRVU)
PPRRVU24_OCT.csv
in
rvu24d.zip
(row 11)
- conversion_factor (col 25)
- 33.2875
How much did Medicare pay for CPT 99308 in Q4 2024? Copy link
Medicare paid $73.90 for CPT 99308 in the office (non-facility) setting and $73.90 in a facility under the Q4 2024 Physician Fee Schedule, effective October 2024. These are the national allowed amounts before the ~2% sequestration cut and before locality (GPCI) adjustment. Across payment localities, both settings' amount is $68.59–$96.55. This price has been unchanged since Q1 2024, when it decreased 0.9%.
Source: Physician relative value file (Q4 2024) · effective October 2024 · materially updated Aug 13, 2026 · compact facts
Why this amount?
- Status A (Active): Medicare calculates a national payment amount for this code and pays it separately when the service is covered.
- Q4 2024 conversion factor: $33.2875.
- National baseline uses GPCI 1.000 — enter a ZIP for your locality's payable amount.
CMS evidence · 2 sources
Open evidence
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Rates by locality Copy link
The amounts above use GPCI 1.000, a national baseline no locality actually bills at. Medicare rescales every code by the local Geographic Practice Cost Indices before paying it, so what 99308 pays depends on where the service is furnished. Tap a state for its localities.
99308 non-facility rate by metro area
Highest-paying metro first. Each figure is that payment locality's own GPCI-adjusted amount.
Anchorage, AK
$96.55
Locality 02102-01
San Jose, CA
$88.51
Locality 01112-09
San Francisco, CA
$87.62
Locality 01112-05
Long Island, NY
$84.97
Locality 13202-02
Queens, NY
$83.48
Locality 13292-04
New York City, NY
$83.26
Locality 13202-01
Washington, DC
$82.17
Locality 12202-01
Show 55 more metros Show fewer metros
Northern New Jersey, NJ
$81.52
Locality 12402-01
Seattle, WA
$81.40
Locality 02402-02
Boston, MA
$80.84
Locality 14212-01
Los Angeles, CA
$80.15
Locality 01182-18
Miami, FL
$79.14
Locality 09102-04
San Diego, CA
$79.10
Locality 01182-72
Ventura County, CA
$79.03
Locality 01182-17
Sacramento, CA
$78.36
Locality 01112-63
Hartford, CT
$77.98
Locality 13102-00
Chicago, IL
$77.89
Locality 06102-16
Baltimore, MD
$77.84
Locality 12302-01
Suburban Chicago, IL
$77.19
Locality 06102-15
Philadelphia, PA
$76.93
Locality 12502-01
Riverside, CA
$76.75
Locality 01112-62
Honolulu, HI
$76.70
Locality 01212-01
Portland, OR
$76.37
Locality 02302-01
Bakersfield, CA
$76.19
Locality 01112-54
Fort Lauderdale, FL
$76.15
Locality 09102-03
Houston, TX
$75.81
Locality 04412-18
Detroit, MI
$75.79
Locality 08202-01
Fresno, CA
$75.76
Locality 01112-56
Providence, RI
$75.61
Locality 14412-01
Denver, CO
$75.19
Locality 04112-01
Austin, TX
$74.91
Locality 04412-31
Atlanta, GA
$74.20
Locality 10212-01
Dallas, TX
$74.20
Locality 04412-11
Fort Worth, TX
$74.03
Locality 04412-28
Metro East, IL
$73.98
Locality 06102-12
Tampa, FL
$73.64
Locality 09102-99
Las Vegas, NV
$73.43
Locality 01312-00
Portland, ME
$73.20
Locality 14112-03
Richmond, VA
$72.81
Locality 11302-00
Phoenix, AZ
$72.77
Locality 03102-00
New Orleans, LA
$72.57
Locality 07202-01
St. Louis, MO
$72.55
Locality 05302-01
Minneapolis, MN
$72.49
Locality 06202-00
Kansas City, MO
$72.44
Locality 05302-02
San Antonio, TX
$72.18
Locality 04412-99
Albuquerque, NM
$71.87
Locality 04212-05
Salt Lake City, UT
$71.84
Locality 03502-09
Buffalo, NY
$71.69
Locality 13282-99
Pittsburgh, PA
$71.66
Locality 12502-99
Columbus, OH
$71.54
Locality 15202-00
Charleston, SC
$70.95
Locality 11202-01
Charlotte, NC
$70.85
Locality 11502-00
Milwaukee, WI
$70.71
Locality 06302-00
Oklahoma City, OK
$70.33
Locality 04312-00
Louisville, KY
$70.24
Locality 15102-00
Indianapolis, IN
$70.20
Locality 08102-00
Wichita, KS
$69.92
Locality 05202-00
Des Moines, IA
$69.87
Locality 05102-00
Boise, ID
$69.74
Locality 02202-00
Nashville, TN
$69.66
Locality 10312-35
Omaha, NE
$69.52
Locality 05402-00
Birmingham, AL
$69.01
Locality 10112-00
99308 facility rate by metro area
Highest-paying metro first. Each figure is that payment locality's own GPCI-adjusted amount.
Anchorage, AK
$96.55
Locality 02102-01
San Jose, CA
$88.51
Locality 01112-09
San Francisco, CA
$87.62
Locality 01112-05
Long Island, NY
$84.97
Locality 13202-02
Queens, NY
$83.48
Locality 13292-04
New York City, NY
$83.26
Locality 13202-01
Washington, DC
$82.17
Locality 12202-01
Show 55 more metros Show fewer metros
Northern New Jersey, NJ
$81.52
Locality 12402-01
Seattle, WA
$81.40
Locality 02402-02
Boston, MA
$80.84
Locality 14212-01
Los Angeles, CA
$80.15
Locality 01182-18
Miami, FL
$79.14
Locality 09102-04
San Diego, CA
$79.10
Locality 01182-72
Ventura County, CA
$79.03
Locality 01182-17
Sacramento, CA
$78.36
Locality 01112-63
Hartford, CT
$77.98
Locality 13102-00
Chicago, IL
$77.89
Locality 06102-16
Baltimore, MD
$77.84
Locality 12302-01
Suburban Chicago, IL
$77.19
Locality 06102-15
Philadelphia, PA
$76.93
Locality 12502-01
Riverside, CA
$76.75
Locality 01112-62
Honolulu, HI
$76.70
Locality 01212-01
Portland, OR
$76.37
Locality 02302-01
Bakersfield, CA
$76.19
Locality 01112-54
Fort Lauderdale, FL
$76.15
Locality 09102-03
Houston, TX
$75.81
Locality 04412-18
Detroit, MI
$75.79
Locality 08202-01
Fresno, CA
$75.76
Locality 01112-56
Providence, RI
$75.61
Locality 14412-01
Denver, CO
$75.19
Locality 04112-01
Austin, TX
$74.91
Locality 04412-31
Atlanta, GA
$74.20
Locality 10212-01
Dallas, TX
$74.20
Locality 04412-11
Fort Worth, TX
$74.03
Locality 04412-28
Metro East, IL
$73.98
Locality 06102-12
Tampa, FL
$73.64
Locality 09102-99
Las Vegas, NV
$73.43
Locality 01312-00
Portland, ME
$73.20
Locality 14112-03
Richmond, VA
$72.81
Locality 11302-00
Phoenix, AZ
$72.77
Locality 03102-00
New Orleans, LA
$72.57
Locality 07202-01
St. Louis, MO
$72.55
Locality 05302-01
Minneapolis, MN
$72.49
Locality 06202-00
Kansas City, MO
$72.44
Locality 05302-02
San Antonio, TX
$72.18
Locality 04412-99
Albuquerque, NM
$71.87
Locality 04212-05
Salt Lake City, UT
$71.84
Locality 03502-09
Buffalo, NY
$71.69
Locality 13282-99
Pittsburgh, PA
$71.66
Locality 12502-99
Columbus, OH
$71.54
Locality 15202-00
Charleston, SC
$70.95
Locality 11202-01
Charlotte, NC
$70.85
Locality 11502-00
Milwaukee, WI
$70.71
Locality 06302-00
Oklahoma City, OK
$70.33
Locality 04312-00
Louisville, KY
$70.24
Locality 15102-00
Indianapolis, IN
$70.20
Locality 08102-00
Wichita, KS
$69.92
Locality 05202-00
Des Moines, IA
$69.87
Locality 05102-00
Boise, ID
$69.74
Locality 02202-00
Nashville, TN
$69.66
Locality 10312-35
Omaha, NE
$69.52
Locality 05402-00
Birmingham, AL
$69.01
Locality 10112-00
Q4 2024 amounts, computed with each locality's own GPCIs, before the ~2% sequestration cut. A state with more than one payment locality shows a range — its tile is colored by the mean across those localities, which is a shading choice, not an amount anyone is paid.
How this amount is computed Copy link
CPT 99308 has a work RVU of 1.30, a non-facility practice expense RVU of 0.83, a facility practice expense RVU of 0.83 and a malpractice RVU of 0.09 — for total non-facility RVUs of 2.22 and total facility RVUs of 2.22 in the Q4 2024 release.
amount = (work RVU × work GPCI + PE RVU × PE GPCI + MP RVU × MP GPCI) × conversion factor. National amounts use GPCI = 1.000. To price an RVU figure of your own, use the RVU-to-dollars converter.
| Component | RVU |
|---|---|
| Work RVU | 1.30 |
| Practice expense RVU (non-facility) | 0.83 |
| Practice expense RVU (facility) | 0.83 |
| Malpractice RVU | 0.09 |
Every rate combines three parts: work (the clinician’s time, skill and effort), practice expense (office overhead — higher when the service is done in a doctor’s own office), and malpractice (the share of liability-insurance cost). A blank means CMS publishes no national number for that part. Read it as unknown, and never as zero.
What does 99308 cost? Copy link
Four numbers get called the cost of a code. Each answers a different question.
Computed from the Q4 2024 CMS release
- Medicare allowed amount
- $73.90
- Medicare's share
- $59.12
- Patient coinsurance
- $14.78
- Limiting charge
- $80.74
What Medicare recognizes as the full price for 99308 in the office (non-facility) setting. Every figure below derives from it.
80% of the allowed amount, before the ~2% sequestration cut.
The remaining 20%, once the annual Part B deductible is met. Medigap or Medicaid often covers it.
The ceiling a non-participating provider can bill a patient on an unassigned claim — 109.25% of the allowed amount.
National Q4 2024 figures at GPCI 1.000. Adjust for your locality and sequestration, or see the questions below for each figure in full.
Common questions Copy link
Is $73.90 what a practice actually receives?
It's the national allowed amount — the starting point. Medicare pays 80% of it ($59.12) and the patient owes 20% coinsurance ($14.78). Sequestration trims Medicare's share by about 2%, your locality's GPCIs scale the total up or down, and the expected-payment calculator applies all three. What lands is practice revenue: staff, space, equipment and billing, not clinician take-home pay. The practice-expense RVU above is CMS's estimate of that overhead share.
Sources: Budget Control Act sequestration provisions; CMS Medicare Fee-for-Service payment guidance; CMS Geographic Practice Cost Index (GPCI) files; CMS Physician Fee Schedule overview (cms.gov).
What's the non-participating amount for 99308?
$70.21 in the office (non-facility) setting — 95% of the $73.90 participating fee schedule amount above. A participating provider takes the fee schedule amount as payment in full on every claim. A non-participating provider is paid this reduced amount, but chooses claim by claim whether to accept assignment. See participating vs non-participating.
Sources: CMS Physician Fee Schedule overview (cms.gov); CMS Medicare Fee-for-Service payment guidance.
What's the limiting charge for 99308?
$80.74 in the office (non-facility) setting — the ceiling on what a non-participating provider can bill the patient on an unassigned claim. That's 109.25% of the $73.90 amount above. The non-participating amount is 95% of the fee schedule rate ($70.21), and the statutory cap is 115% of that. See limiting charge.
Sources: CMS Physician Fee Schedule overview (cms.gov); CMS Medicare Fee-for-Service payment guidance.
Why would a Medicare claim for 99308 be denied or paid less?
These come from CMS indicators on this page, not general billing advice.
- Bilateral surgery: no bilateral adjustment. See billing policy
- Assistant at surgery: restricted without documentation. See billing policy
- Co-surgeons: not permitted. See billing policy
- Team surgery: not permitted. See billing policy
Payer-specific coverage and documentation rules live outside these files, so a claim that clears every check here can still be denied on other grounds.
When does this rate change?
CMS publishes a fee schedule release every quarter (January, April, July, October), and each is versioned here. The 99308 rate last moved in Q1 2026 (+9.8% non-facility) — see its rate history or what changed each release, or get an email when a new release moves rates.
Sources: CMS Medicare Physician Fee Schedule Relative Value Files.
Applicable payment rules Copy link
Only the rules that can matter for 99308, each linking to its detail on this page.
Modifier amounts: -26/TC, -50, -80/81/82, -AS, -62, -66 Copy link
National non-facility amounts for the modifiers this code's indicators support. Single-line modifiers only. -51 (multiple-procedure reduction) depends on the other codes on the same claim, so it's a claim-level number rather than a per-code one. Use the calculator for a locality-adjusted, sequestration-aware amount.
| Modifier | What it means | Amount |
|---|---|---|
| -26/TC | Professional/technical split | Not payable |
| -50 | Bilateral procedure | Not payable |
| -80/81/82 | Assistant surgeon (physician) (16%) | $11.82 If documented |
| -AS | Assistant at surgery (PA, NP, or CNS) (13.6%) | $10.05 If documented |
| -62 | Co-surgeons, each | Not payable |
| -66 | Team surgery | Not payable |
These apply standard MPFS percentages — assistant surgeon 16%, co-surgeon 62.5%, bilateral 150% — to the national non-facility amount above, so its source citation covers them too. They are derived here rather than read from a CMS column: check them against the current Medicare Claims Processing Manual before relying on them for payment. A row marked If documented carries the ordinary percentage, but this code's CMS indicator pays it only when supporting documentation of medical necessity is submitted — an unpaid claim without that documentation is not an underpayment.
Can you bill it with another code? Copy link
Enter a second CPT or HCPCS code billed on the same date of service. We'll check the current NCCI procedure-to-procedure edit between it and 99308.
Rate history by release Copy link
National non-facility amount for 99308 across quarterly releases. +14.0% increase since Q2 2014 · high $78.83 in Q1 2026
| Release | Status | Non-facility | Facility |
|---|---|---|---|
| Q3 2026 Jul 1, 2026 – present | A | $78.83 (0.0% no change ) | $67.80 (0.0% no change ) |
| Q2 2026 Apr 1, 2026 – Jun 30, 2026 | A | $78.83 (0.0% no change ) | $67.80 (0.0% no change ) |
| Q1 2026 Jan 1, 2026 – Mar 31, 2026 | A | $78.83 (+9.8% increase ) | $67.80 (-5.6% decrease ) |
| Q4 2025 Oct 1, 2025 – Dec 31, 2025 | A | $71.81 (0.0% no change ) | $71.81 (0.0% no change ) |
| Q3 2025 Jul 1, 2025 – Sep 30, 2025 | A | $71.81 (0.0% no change ) | $71.81 (0.0% no change ) |
| Q2 2025 Apr 1, 2025 – Jun 30, 2025 | A | $71.81 (0.0% no change ) | $71.81 (0.0% no change ) |
| Q1 2025 Jan 1, 2025 – Mar 31, 2025 | A | $71.81 (-2.8% decrease ) | $71.81 (-2.8% decrease ) |
| Q4 2024 Oct 1, 2024 – Dec 31, 2024 | A | $73.90 (0.0% no change ) | $73.90 (0.0% no change ) |
| Q3 2024 Jul 1, 2024 – Sep 30, 2024 | A | $73.90 (0.0% no change ) | $73.90 (0.0% no change ) |
| Q2 2024 Apr 1, 2024 – Jun 30, 2024 | A | $73.90 (0.0% no change ) | $73.90 (0.0% no change ) |
| Q1 2024 Jan 1, 2024 – Mar 31, 2024 | A | $73.90 (-0.9% decrease ) | $73.90 (-0.9% decrease ) |
| Q4 2023 Oct 1, 2023 – Dec 31, 2023 | A | $74.55 (0.0% no change ) | $74.55 (0.0% no change ) |
| Q3 2023 Jul 1, 2023 – Sep 30, 2023 | A | $74.55 (0.0% no change ) | $74.55 (0.0% no change ) |
| Q2 2023 Apr 1, 2023 – Jun 30, 2023 | A | $74.55 (0.0% no change ) | $74.55 (0.0% no change ) |
| Q1 2023 Jan 1, 2023 – Mar 31, 2023 | A | $74.55 (+8.2% increase ) | $74.55 (+8.2% increase ) |
| Q4 2022 Oct 1, 2022 – Dec 31, 2022 | A | $68.87 (0.0% no change ) | $68.87 (0.0% no change ) |
| Q3 2022 Jul 1, 2022 – Sep 30, 2022 | A | $68.87 (0.0% no change ) | $68.87 (0.0% no change ) |
| Q2 2022 Apr 1, 2022 – Jun 30, 2022 | A | $68.87 (0.0% no change ) | $68.87 (0.0% no change ) |
| Q1 2022 Jan 1, 2022 – Mar 31, 2022 | A | $68.87 (-0.3% decrease ) | $68.87 (-0.3% decrease ) |
| Q4 2021 Oct 1, 2021 – Dec 31, 2021 | A | $69.09 (0.0% no change ) | $69.09 (0.0% no change ) |
| Q3 2021 Jul 1, 2021 – Sep 30, 2021 | A | $69.09 (0.0% no change ) | $69.09 (0.0% no change ) |
| Q2 2021 Apr 1, 2021 – Jun 30, 2021 | A | $69.09 (0.0% no change ) | $69.09 (0.0% no change ) |
| Q1 2021 Jan 1, 2021 – Mar 31, 2021 | A | $69.09 (-1.8% decrease ) | $69.09 (-1.8% decrease ) |
| Q4 2020 Oct 1, 2020 – Dec 31, 2020 | A | $70.37 (0.0% no change ) | $70.37 (0.0% no change ) |
| Q3 2020 Jul 1, 2020 – Sep 30, 2020 | A | $70.37 (0.0% no change ) | $70.37 (0.0% no change ) |
| Q2 2020 Apr 1, 2020 – Jun 30, 2020 | A | $70.37 (0.0% no change ) | $70.37 (0.0% no change ) |
| Q1 2020 Jan 1, 2020 – Mar 31, 2020 | A | $70.37 (+0.6% increase ) | $70.37 (+0.6% increase ) |
| Q4 2019 Oct 1, 2019 – Dec 31, 2019 | A | $69.92 (0.0% no change ) | $69.92 (0.0% no change ) |
| Q3 2019 Jul 1, 2019 – Sep 30, 2019 | A | $69.92 (0.0% no change ) | $69.92 (0.0% no change ) |
| Q2 2019 Apr 1, 2019 – Jun 30, 2019 | A | $69.92 (0.0% no change ) | $69.92 (0.0% no change ) |
| Q1 2019 Jan 1, 2019 – Mar 31, 2019 | A | $69.92 (-0.9% decrease ) | $69.92 (-0.9% decrease ) |
| Q4 2018 Oct 1, 2018 – Dec 31, 2018 | A | $70.56 (0.0% no change ) | $70.56 (0.0% no change ) |
| Q3 2018 Jul 1, 2018 – Sep 30, 2018 | A | $70.56 (0.0% no change ) | $70.56 (0.0% no change ) |
| Q2 2018 Apr 1, 2018 – Jun 30, 2018 | A | $70.56 (0.0% no change ) | $70.56 (0.0% no change ) |
| Q1 2018 Jan 1, 2018 – Mar 31, 2018 | A | $70.56 (+0.8% increase ) | $70.56 (+0.8% increase ) |
| Q4 2017 Oct 1, 2017 – Dec 31, 2017 | A | $69.98 (0.0% no change ) | $69.98 (0.0% no change ) |
| Q3 2017 Jul 1, 2017 – Sep 30, 2017 | A | $69.98 (0.0% no change ) | $69.98 (0.0% no change ) |
| Q2 2017 Apr 1, 2017 – Jun 30, 2017 | A | $69.98 (0.0% no change ) | $69.98 (0.0% no change ) |
| Q1 2017 Jan 1, 2017 – Mar 31, 2017 | A | $69.98 (+0.2% increase ) | $69.98 (+0.2% increase ) |
| Q4 2016 Oct 1, 2016 – Dec 31, 2016 | A | $69.82 (0.0% no change ) | $69.82 (0.0% no change ) |
| Q3 2016 Jul 1, 2016 – Sep 30, 2016 | A | $69.82 (0.0% no change ) | $69.82 (0.0% no change ) |
| Q2 2016 Apr 1, 2016 – Jun 30, 2016 | A | $69.82 (0.0% no change ) | $69.82 (0.0% no change ) |
| Q1 2016 Jan 1, 2016 – Mar 31, 2016 | A | $69.82 (+0.7% increase ) | $69.82 (+0.7% increase ) |
| Q4 2015 Oct 1, 2015 – Dec 31, 2015 | A | $69.35 (+0.5% increase ) | $69.35 (+0.5% increase ) |
| Q3 2015 Jul 1, 2015 – Sep 30, 2015 | A | $69.01 (0.0% no change ) | $69.01 (0.0% no change ) |
| Q2 2015 Apr 1, 2015 – Jun 30, 2015 | A | $69.01 (0.0% no change ) | $69.01 (0.0% no change ) |
| Q1 2015 Jan 1, 2015 – Mar 31, 2015 | A | $69.01 (-0.2% decrease ) | $69.01 (-0.2% decrease ) |
| Q4 2014 Oct 1, 2014 – Dec 31, 2014 | A | $69.14 (0.0% no change ) | $69.14 (0.0% no change ) |
| Q3 2014 Jul 1, 2014 – Sep 30, 2014 | A | $69.14 (0.0% no change ) | $69.14 (0.0% no change ) |
| Q2 2014 Apr 1, 2014 – Jun 30, 2014 | A | $69.14 | $69.14 |
Contracted rate: % of Medicare Copy link
Commercial payer contracts usually price off the Medicare amount above ("BCBS pays 115% of Medicare"). Enter your contract's percentage below to see what 99308 pays at that rate — $73.90 is 100%.
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How often 99308 is billed Copy link
Across Original Medicare in CY2024, 99308 ranked #32 of the 7,879 CPT codes billed to Medicare that year, by patients served or total allowed dollars. It repeats: a patient billed for it in 2024 was billed 7.4 times on average that year.
2024 Medicare fee-for-service national totals. They exclude Medicare Advantage, Medicaid and commercial volume, so real-world use runs higher. This is a calendar-year snapshot from the CMS Physician & Other Practitioners dataset, on a different cycle from the Q4 2024 fee schedule above.
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Source & method
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This is computed from CMS's Medicare Physician Fee Schedule Q4 2024 release (schedule pfs, effective October 2024). National amounts apply a GPCI of 1.000 and leave sequestration off. The status indicator decides payability, never the RVU values, so a blank RVU stays blank. Releases are immutable: a rate retrieved for a past quarter always reflects that release. Modifier amounts apply standard MPFS percentages to this code's billing indicators. We derive them here rather than read them from CMS, so confirm them against the current Claims Processing Manual before relying on them for payment. Our methodology covers the depth: sourcing, parsing, versioning, and how we cross-check claims before they ship.
Conversion factor $33.2875 read from the same file, row 11, column 25.
Use the (i) buttons next to each amount above for the exact row, columns, and math.
Cite this rate
This link keeps pointing at the Q4 2024 figures, even after a newer release lands.
CPT 99308 Medicare Physician Fee Schedule rate: $73.90 (Q4 2024). Localis. https://localishealth.com/cpt/99308/2024/D