The 99342 CPT code reports an evaluation and management (E/M) visit for a new patient in their home or residence. A visit qualifies with low medical decision making (MDM) or at least 30 minutes of total practitioner time on the date of service.
The code is active in 2026, and Medicare pays $78.83 at the national non-facility rate for practitioners outside an Advanced APM. Two updates change how you bill it this year: G2211 became payable with home visits on January 1, 2026, and MACs switched on the matching claim edits on October 5, 2026.
Plenty of coding pages still list 99343, the old 45 minute time anchors, or domiciliary codes 99324 to 99337. Those rules ended on January 1, 2023. Everything in this guide comes from the current AMA descriptor, the CY2026 Physician Fee Schedule, and Noridian’s home visit guidance.
99342 CPT Code at a Glance (2026)
| Item | Detail |
|---|---|
| Code type | Category I CPT, E/M, home or residence services |
| Patient status | New: no professional services from the same practitioner or same specialty group in three years |
| Code selection | Low MDM, or 30 minutes or more of total time on the date of the encounter |
| Travel time | Not counted |
| Place of service | 12, 13, 14, 33, or 55, based on the residence type |
| 2026 Medicare rate | $78.83 national non-facility (non-QP); $79.22 (QP) |
| Total RVUs | 2.36 (1.65 work, 0.64 practice expense, 0.07 malpractice) |
| Global period | XXX |
| Add-on options | G2211 from January 1, 2026; no prolonged service code |
| Telehealth | Home originating site allowed through December 31, 2027 (POS 10); confirm the current CMS list |
Sources: AMA CPT E/M guidelines (2023 update); CMS CY2026 Physician Fee Schedule, national non-facility amounts.
What Is the 99342 CPT Code?
CPT code 99342 is a Category I E/M code for a new patient seen at home or another residence. It belongs to the home or residence services family, 99341 to 99350, which the AMA rebuilt for 2023 around MDM or total time. History and exam still belong in the note, but they no longer set the level.
Official 99342 CPT Code Description
The AMA publishes the descriptor in its 2023 E/M descriptors and guidelines. Payers and auditors read your notes against this wording:
“Home or residence visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.”
Two phrases in that descriptor carry the billing weight. Low sets the MDM floor, and 30 minutes sets the time floor. Meet either one and the visit supports 99342; miss both and you’re looking at 99341, the straightforward level.
What Counts as a Home or Residence for CPT 99342?
CPT uses a wide definition of home. It covers a private residence, temporary lodging, and short-term accommodation such as a hotel, campground, hostel, or cruise ship. The definition also takes in assisted living, group homes not licensed as an ICF/IID, custodial care facilities, and residential substance abuse treatment facilities.
Patients in an intermediate care facility for individuals with intellectual disabilities (ICF/IID) or a psychiatric residential treatment center fall under nursing facility codes instead. For the wider group of codes used in home settings, see our guide to home health CPT codes.
Is CPT 99342 Still Valid in 2026?
Yes. CPT 99342 is active in 2026, and Medicare pays it under the Physician Fee Schedule at a national rate of $78.83. The code kept its number through the 2023 rebuild with a new descriptor, while its old neighbor 99343 disappeared. Most 2026 home visit denials trace back to claims built on those older rules.
99342 Time Requirements: The 30 Minute Rule
The 99342 CPT code requires 30 minutes or more of total practitioner time on the date of the encounter when you select the level by time. You add up face-to-face and non face-to-face work across that calendar day, as long as the billing practitioner did the work.
Time and MDM are alternatives. Score both, pick the method that supports the higher level, and document the one you used. A visit with 32 minutes of total time and straightforward MDM still supports 99342 on time.
Activities That Count Toward 99342 Time
Count the practitioner’s own time on the date of service for these activities:
- Preparing for the visit, including review of outside records and test results
- Obtaining or reviewing history from the patient, family, or another source
- Performing a medically appropriate exam or evaluation
- Counseling and educating the patient, family, or caregiver
- Ordering medications, tests, or procedures
- Referring to and communicating with other health care professionals, when not reported as its own service
- Documenting in the record and coordinating care
Activities That Don’t Count
Travel time doesn’t count, and neither does time spent on services you report with their own codes or time clinical staff spend on their own. A drive of 25 minutes plus a visit of 20 minutes adds up to 20 minutes for coding, which lands on 99341 unless MDM reaches low.
Write the time statement so a reviewer can add it up without guessing. A version that holds up in review looks like this:
| Sample Time StatementTotal time on date of service: 41 minutes (chart review 8, history and exam 18, counseling 10, documentation 5). Travel time excluded. |
Can You Bill Prolonged Time With 99342?
No. Prolonged service codes don’t attach to 99342. CPT 99417 applies only to 99345 and 99350, the top home levels, and Medicare uses G0318 instead, starting at 140 minutes with 99345 and 110 minutes with 99350. Our CPT code 99417 guide explains how those thresholds work.
A long visit that starts at the 99342 level should move up to 99344 or 99345 once total time reaches 60 or 75 minutes. Medicare also won’t pay non face-to-face prolonged codes 99358 and 99359 on the same date as a home visit.
Low Medical Decision Making for CPT 99342
Low MDM requires two of three elements at the low level or higher: the number and complexity of problems, the amount and complexity of data, and the risk of patient management. Check each element against the 99342 level with the table below.
Low MDM Elements for 99342
| Element | Low MDM threshold | Home visit example |
|---|---|---|
| Problems | 2 or more self-limited or minor problems; 1 stable chronic illness; 1 acute, uncomplicated illness or injury; or 1 stable acute illness | Hypertension at goal |
| Data | Limited: any 2 of review of external notes from each unique source, review of each unique test result, or ordering each unique test; or assessment requiring an independent historian | Review the hospital discharge note and order a CBC |
| Risk | Low risk of morbidity from additional testing or treatment | Over-the-counter medication advice or a PT referral |
Source: AMA CPT E/M guidelines (2023 update). Prescription drug management counts as moderate risk.
The word stable trips up a lot of home visit claims. CPT defines stable as at the patient’s treatment goal, so a diabetic with an A1c above target has a chronic illness with progression, which scores moderate. Prescription drug management pushes risk to moderate as well.
Three Scenarios: 99342 or a Different Level?
Scenario 1. A new assisted living resident scraped a forearm in a fall two days ago. The practitioner cleans the wound, reviews the facility’s incident note, and orders a wrist X-ray. One acute, uncomplicated injury plus limited data supports low MDM. Result: 99342.
Scenario 2. A homebound new patient has hypertension at goal. The practitioner reviews the cardiology note and a recent metabolic panel, then counsels on salt intake and home blood pressure checks without touching the medication list. One stable chronic illness and limited data support 99342. Result: 99342.
Scenario 3. A new patient with heart failure gained four pounds in three days. The practitioner raises the diuretic dose and orders labs. A chronic illness with exacerbation and prescription drug management both reach moderate. Result: 99344.
Office coders already know this grid from 99203, the office visit for a new patient at low MDM or 30 minutes. Our CPT code 99203 guide compares the office side if your coders work both settings.
Coders who carry office habits into home visits tend to drift on MDM levels, and small errors add up over a year. ClaimMax’s medical billing services include coder review of MDM and time on each home visit claim before it leaves your system.
New Patient Rules for the 99342 CPT Code
A new patient hasn’t received any professional services from the same physician or qualified health care professional, or from another practitioner of the exact same specialty and subspecialty in the same group, within the past three years. Professional services here means face-to-face services reported with a CPT code.
The Three Year Rule and the Same Specialty Test
CPT treats nurse practitioners and physician assistants as the same specialty as the physicians they work with. A family medicine NP who saw the patient in the office last year makes that patient established for the group’s family physicians at home.
Covering practitioners follow the same logic. A doctor covering for an absent colleague classifies the visit the way the absent colleague would have, so coverage can’t turn an established patient into a new one.
A Common New Patient Trap
An internist sees a patient in the office in March 2025. In August 2026, a physician in the same group and specialty visits that patient at home. The home visit is established, so it belongs in 99347 to 99350, and a 99342 claim will deny or get recouped. Our 99347 CPT code guide covers the established side.
How Often Can 99342 Be Billed?
In most cases, you bill 99342 once per patient for each practitioner or same specialty group. Later home visits by that practitioner or specialty within three years are established. A second 99342 for the same patient inside that window stands out in automated audits.
Run a three year look back in your practice management system before the first visit. Our insurance eligibility verification services confirm active coverage and plan rules before the visit goes on the schedule.
Place of Service Codes for CPT 99342
You report CPT 99342 with one of five POS codes, chosen by where the patient lives: 12, 13, 14, 33, or 55. The CMS Evaluation and Management Services booklet ties home and residence codes to these settings. POS 11 (office) doesn’t fit a home visit.
POS Codes and 99342
| POS | Setting | Use 99342? |
|---|---|---|
| 12 | Home | Yes |
| 13 | Assisted living facility | Yes |
| 14 | Group home (not licensed as an ICF/IID) | Yes |
| 33 | Custodial care facility | Yes |
| 55 | Residential substance abuse treatment facility | Yes |
| 31 or 32 | Skilled nursing facility or nursing facility | No; use 99304 to 99310 |
| 11 | Office | No |
| 10 or 02 | Telehealth | Only under Medicare telehealth rules |
Source: CMS MLN006764 and the CMS POS code set.
Can 99342 Be Billed in Assisted Living?
Yes. Since January 1, 2023, assisted living visits use the home or residence codes with POS 13. The AMA deleted domiciliary codes 99324 to 99328, which used to cover these visits, so a new resident seen at the low level gets billed as 99342.
Settings Where 99342 Doesn’t Apply
Skilled nursing and nursing facility residents (POS 31 and 32) use 99304 to 99310. Our 99306 CPT code guide covers the high level initial nursing facility visit. Patients in an ICF/IID or psychiatric residential treatment center also fall under the nursing facility codes.
Physical Presence Requirement
A POS 12 claim tells Medicare the practitioner was in the home. Noridian’s home visit guidance requires the practitioner’s physical presence for home and residence codes, and a video visit filed with POS 12 misstates where the service happened.
Older MAC articles still use domiciliary language and pre-2023 code numbers. If an article conflicts with the 2023 CPT descriptor, follow the current descriptor and the CMS booklet. Our guide to place of service 12 covers home claim setup in more depth.
POS mismatches are some of the quickest denials to fix and the easiest to prevent. ClaimMax’s denial management services track POS denials by root cause, so your team fixes the source instead of reworking the same error next month.
99341 vs 99342 vs 99344 vs 99345: Code Comparison
With 99343 gone, the new patient home codes now run in four levels. The AAFP home visit coding guide lays out the same structure for family physicians. Compare MDM and time across the full family in the table below.
Home or Residence E/M Codes (2026)
| Code | Patient status | MDM level | Total time |
|---|---|---|---|
| 99341 | New | Straightforward | 15 minutes |
| 99342 | New | Low | 30 minutes |
| 99343 | Deleted January 1, 2023 | Not applicable | Not applicable |
| 99344 | New | Moderate | 60 minutes |
| 99345 | New | High | 75 minutes |
| 99347 | Established | Straightforward | 20 minutes |
| 99348 | Established | Low | 30 minutes |
| 99349 | Established | Moderate | 40 minutes |
| 99350 | Established | High | 60 minutes |
Source: AMA CPT E/M guidelines (2023 update). Time thresholds must be met or exceeded.
Established patients at the moderate level have their own rules for time and MDM. Our CPT code 99349 guide walks through that level with examples.
What Replaced CPT 99343?
No single code replaced 99343. On January 1, 2023, the AMA deleted it and spread the new patient home levels across 99341, 99342, 99344, and 99345. A visit that met the old 99343 standard of moderate complexity now maps to 99344, and a time based visit depends on the minutes in the note.
Deleted Domiciliary Codes and Their Replacements
Deleted Codes Crosswalk
| Deleted codes | Report instead |
|---|---|
| 99324 to 99328 (new patient domiciliary) | 99341 to 99345 |
| 99334 to 99337 (established patient domiciliary) | 99347 to 99350 |
| 99339 and 99340 (care plan oversight) | Care management codes such as 99437, 99491, 99424, and 99425 |
All deletions took effect January 1, 2023.
The 30 to 59 Minute Gap
Time thresholds jump from 30 minutes for 99342 to 60 minutes for 99344. A visit with 45 or 55 minutes of total time still reports 99342 on time, unless MDM reaches moderate and supports 99344. On longer visits, score both methods before you pick the code.
99342 vs 99348
Both codes require low MDM or 30 minutes. Patient status is the only difference: 99342 is new and 99348 is established. Billing 99342 for an established patient is a common audit target, since the payer’s own claim history shows the earlier visit.
99342 CPT Code Reimbursement: 2026 Medicare Rate and RVUs
The 2026 national Medicare rate for the 99342 CPT code is $78.83 for practitioners who don’t qualify through an Advanced APM, using the $33.4009 conversion factor. Qualifying APM participants (QPs) get the $33.5675 conversion factor, which brings the rate to $79.22.
99342 RVU Breakdown (CY2026)
| Component | Value |
|---|---|
| Work RVU | 1.65 |
| Practice expense RVU | 0.64 |
| Malpractice RVU | 0.07 |
| Total RVUs | 2.36 |
| National rate, non-QP ($33.4009) | $78.83 |
| National rate, QP ($33.5675) | $79.22 |
| Global period | XXX |
Source: CMS CY2026 Physician Fee Schedule. Facility and non-facility totals match for 99342.
Why Two Conversion Factors in 2026?
CY2026 is the first year CMS applies two conversion factors: one for qualifying APM participants and one for everyone else. Most independent practices billing home visits fall under the non-QP factor of $33.4009, so $78.83 is the national figure they’ll see.
99342 Rates by Locality
Medicare adjusts the national rate with geographic practice cost indices (GPCIs), so your local payment differs. State averages for 99342 run from about $75 in Arkansas to about $107 in Alaska. Pull your exact locality from the CMS PFS Look-Up Tool before you set fee schedules or audit payments.
NP and PA Payment for 99342
Nurse practitioners and physician assistants billing under their own NPI receive 85% of the fee schedule amount. At the national rate, that comes to about $67.01 for 99342.
Claims still billed with 99343 get no payment, since the code no longer exists in the fee schedule. To confirm each payment matches the allowed amount, our payment posting services flag underpayments line by line.
G2211 With 99342 in 2026
Starting January 1, 2026, CMS pays add-on code G2211 with home or residence E/M visits. The descriptor now covers “home or residence or office/outpatient” visits for new or established patients, so a first home visit billed as 99342 can qualify.
Does G2211 Fit a New Patient Home Visit?
Yes, as long as the relationship is ongoing. G2211 pays for the work of serving as the patient’s continuing focal point for care, or for ongoing care of a single serious or complex condition, and that relationship can start at the first visit. A one-time visit with no plan for follow-up care doesn’t support it.
99342 Plus G2211 Payment
G2211 carries 0.33 work RVUs and 0.52 total RVUs, about $17.37 at the national non-facility rate. Billed together, 99342 and G2211 pay about $96.20 at the national rate, a lift of about 22% on each qualifying visit.
Modifier 25 and the G2211 Exception
Medicare won’t pay G2211 when the E/M carries modifier 25, with one exception. CMS change request 14447, issued in transmittal R13753CP on May 7, 2026, extends that exception to home or residence visits.
Under the exception, Medicare pays G2211 on a modifier 25 visit when the other same day service is an annual wellness visit, vaccine administration, or a Medicare Part B preventive service. Any other same day procedure still blocks the add-on.
G2211 With 99342 and Modifier 25
| Same day service billed with 99342-25 | G2211 payable? |
|---|---|
| Annual wellness visit, vaccine administration, or Part B preventive service | Yes |
| Any other procedure or service, such as a minor procedure | No |
Source: CMS transmittal R13753CP (CR 14447), effective January 1, 2026.
Annual wellness visits often pair with this exception on home visit days. Our G0439 CPT code guide covers the subsequent AWV and how it sits next to a problem oriented E/M.
Claims Before October 5, 2026
The exception took effect January 1, 2026, but MACs implemented the edits on October 5, 2026. Check the transmittal’s instructions, then contact your MAC about any home visit claims with G2211 and modifier 25 that denied between January 1 and October 4, 2026.
Keeping add-on rules and MAC dates straight on each home visit takes time most front desks don’t have. ClaimMax’s revenue cycle management team applies these updates to your claims as CMS releases them.
Can 99342 Be Billed via Telehealth?
Home or residence codes appear on the CMS Medicare telehealth services list, and the patient’s home can serve as the originating site through December 31, 2027. CMS updates the list each year, so check the current file before you bill.
- Use POS 10 if the patient is at home and POS 02 if the patient is somewhere else.
- Medicare doesn’t require a modifier for audio-video visits; add modifier 93 for audio-only visits.
- Commercial payers often want modifier 95, so check each contract before you submit.
A POS 12 claim implies physical presence, so don’t report a video visit as POS 12. Our guide to POS 02 in medical billing covers the non-home telehealth setting. For commercial modifier rules, see our modifier 95 guide.
Modifiers, Same Day Services, and Who Can Bill 99342
Most 99342 claims go out with no modifier. The table lists the modifiers you’ll see on home visit claims and the situation each one describes.
Modifiers Used With 99342
| Modifier | Use with 99342 |
|---|---|
| 25 | Significant, separately identifiable E/M on the same day as a procedure or other service |
| 93 | Audio-only telehealth (Medicare) |
| 95 | Synchronous telehealth (many commercial payers) |
| GV | Attending physician not employed or paid under arrangement by the patient’s hospice provider |
| GW | Service not related to the hospice patient’s terminal condition |
Check payer policy for telehealth modifier rules.
Modifier 59 doesn’t belong on E/M codes. For a separate E/M on the same day as a procedure, use modifier 25 and keep the documentation for each service distinct in the note.
Who Can Bill 99342?
Physicians, nurse practitioners, physician assistants, and clinical nurse specialists can report 99342 within their state scope of practice. Incident-to billing doesn’t fit a new patient visit, because incident-to requires a plan of care the physician has already started.
Each practitioner needs active Medicare enrollment before the first home visit claim goes out. Our provider credentialing and enrollment team handles PECOS enrollment and payer contracts for home visit programs.
Documentation Requirements for CPT 99342
Noridian expects each home visit record to show why the visit happened at home and that the care met medical necessity. Run each note through this list before you bill:
- A chief complaint for each visit; a chronic condition on its own doesn’t justify the visit
- Who requested the visit: the patient, family, caregiver, or another provider
- The reason a home visit was needed instead of an office visit
- Visit frequency in line with what office care would require
- Care a visiting nurse or home health agency couldn’t provide
- MDM elements or a total time statement that supports 99342
Medicare treats a visit made for the practitioner’s convenience, with no documented need, as a social visit and won’t pay for it. The chief complaint and the requester carry most of the weight in a review.
Does the Patient Need to Be Homebound?
No. Medicare doesn’t require homebound status for home or residence E/M visits. The record still has to show why the visit took place at home instead of the office. Home health certification is a separate service with its own homebound rules.
Diagnosis Codes That Support the Home Setting
Status Z-codes help explain the home setting next to the primary diagnosis. Z74.09 (other reduced mobility), Z99.3 (dependence on wheelchair), and Z91.81 (history of falling) are valid FY2027 ICD-10-CM codes. List the condition you treated first, then the status code.
Sample 99342 Documentation Note
| Sample Note: 99342 (Low MDM)Setting: Patient’s private residence, POS 12. New patient; no services from this group in the past three years.Requested by: Daughter (caregiver), because the patient depends on a wheelchair after a stroke.Chief complaint: Establish care for right knee osteoarthritis; pain at usual level, caregiver asks for a treatment plan.History and exam: Medically appropriate history; right knee crepitus, no effusion, no warmth.Data: Reviewed outside orthopedic note; ordered right knee X-ray.Assessment: M17.11 unilateral primary osteoarthritis, right knee; Z99.3 dependence on wheelchair.Plan: Acetaminophen per label, ice, home exercise sheet, PT referral.MDM: Low (1 stable chronic illness, limited data, low risk).Total time on date of service: 38 minutes, travel excluded. |
If you’d like a second set of eyes on your notes before a payer asks for them, ClaimMax offers a home visit coding review that checks sample charts against these rules.
Common 99342 Denials and How to Fix Them
Most 99342 denials come from five causes, and each one has a clear fix. Use the table to match the remark on your remittance to the correction.
99342 Denial Codes and Fixes
| Denial | Common cause | Fix |
|---|---|---|
| CO-5 or CO-58 | POS doesn’t match the code, such as POS 11 or 31 | Correct the POS to 12, 13, 14, 33, or 55, or switch to the right code family |
| CO-181 | Deleted code billed (99343 or a domiciliary code) | Recode to 99341 to 99345 based on MDM or time |
| Review recoupment | Established patient billed as new | Check three year history; rebill as 99347 to 99350 |
| CO-50 | Medical necessity not documented | Add the chief complaint and reason for the home setting; appeal with records |
| CO-16 with N290 | Missing or invalid rendering provider NPI | Add the enrolled rendering NPI and resubmit |
CARC and RARC codes from the X12 code lists; payer use varies.
Single denials tell you less than patterns do. A home visit denial review groups denials by code and cause, so your team can fix the front end instead of appealing the same mistake.
Noridian’s Top Denial Reasons
Noridian lists four reasons home visit claims fail medical review. Each one points back to a gap in the note:
- The record doesn’t show who requested the visit
- Visit frequency exceeds what office care would need
- The physician solicited the visit
- Other providers already treat the same diagnosis
Audit Risk: RAC Topics 0011 and 0115
RAC topic 0011 is an automated review across all A/B MACs, and it lists 99342 among the home visit codes checked against inpatient stays. Topic 0115 targets the same overlap, so a home POS claim on a date the patient was an inpatient gets denied.
You have 120 days from the initial determination to file a Medicare redetermination. For older open claims, our aged AR follow-up team works the backlog before filing limits close.
99342 Billing Checklist
Run each 99342 claim through these eight checks before submission:
- Confirm new patient status: no services from the same practitioner or same specialty group in three years.
- Confirm the residence type and choose POS 12, 13, 14, 33, or 55.
- Score MDM at the low level, or record total time of 30 minutes or more.
- Leave travel time out of the time statement.
- Document a chief complaint and the reason for a home visit.
- Add G2211 only if the visit starts an ongoing care relationship.
- Check modifier 25 against the G2211 exception for AWV, vaccines, and preventive services.
- Verify the rendering NPI and Medicare enrollment.
Put these checks into your pre-submission claim edits, and your team catches most home visit errors before the payer sees the claim.
FAQs About the 99342 CPT Code
What is the 99342 CPT code?
The 99342 CPT code is a home or residence E/M service for a new patient. It requires a medically appropriate history or exam plus low MDM, or 30 minutes or more of total practitioner time on the date of the encounter. Travel time doesn’t count. The code applies to private homes, assisted living, group homes, custodial care, and residential substance abuse treatment facilities under POS 12, 13, 14, 33, or 55. Medicare’s 2026 national rate is $78.83.
What is the 2026 reimbursement for CPT 99342?
Medicare pays $78.83 for CPT 99342 at the 2026 national non-facility rate for practitioners outside an Advanced APM, based on 2.36 total RVUs and a $33.4009 conversion factor. Qualifying APM participants receive $79.22. Local rates vary with GPCIs, from about $75 in Arkansas to about $107 in Alaska. NPs and PAs billing under their own NPI receive 85%, about $67.01. Adding G2211 brings the national total to about $96.20 for a qualifying visit.
Can 99342 be billed in assisted living?
Yes. Assisted living visits use the home or residence codes with POS 13, a change that took effect January 1, 2023, when the AMA deleted domiciliary codes 99324 to 99337. You bill a new resident seen at low MDM or for 30 minutes or more of total time as 99342. Skilled nursing and nursing facility residents follow different rules and use 99304 to 99310 with POS 31 or 32. Document the facility type in each note.
Is CPT 99342 still valid in 2026?
Yes. CPT 99342 is active in 2026 and paid under the Medicare Physician Fee Schedule. The descriptor changed in 2023 to use MDM or total time, and a 30 minute threshold replaced the old 30 minute typical time. Two 2026 updates affect the code: G2211 became payable with home visits on January 1, 2026, and the modifier 25 exception for home visits reached MAC systems on October 5, 2026. Guides that still cite 99343 are out of date.
What replaced CPT 99343?
No single code replaced CPT 99343. The AMA deleted it on January 1, 2023, as part of the home and residence services rebuild. New patient home visits now have four levels: 99341, 99342, 99344, and 99345. A visit that met the old 99343 standard of moderate complexity now fits 99344, which requires moderate MDM or 60 minutes of total time. Payers deny claims billed with 99343 as an invalid code, often with CARC 181.
What is the difference between 99341 and 99342?
Both codes report a new patient home or residence visit. 99341 requires straightforward MDM or 15 minutes of total time, and 99342 requires low MDM or 30 minutes. Straightforward MDM covers one self-limited or minor problem with minimal data and minimal risk. Low MDM needs two of three elements at the low level, such as one stable chronic illness plus limited data. Choose the code by MDM or time, whichever supports the higher level.
What are CPT codes 99341 to 99345?
CPT codes 99341 to 99345 are the new patient home or residence E/M codes. 99341 is straightforward MDM or 15 minutes, 99342 is low MDM or 30 minutes, 99344 is moderate MDM or 60 minutes, and 99345 is high MDM or 75 minutes. The AMA deleted 99343 on January 1, 2023. Established patients use 99347 to 99350. None of these codes count travel time, and all of them apply to homes, assisted living, and similar residences.
Can G2211 be billed with 99342?
Yes, starting January 1, 2026. CMS expanded G2211 to home or residence visits for new and established patients, so you can add it to 99342 when the practitioner serves as the patient’s continuing focal point for care. G2211 pays about $17.37 at the national rate. Medicare won’t pay it with modifier 25 unless the same day service is an AWV, vaccine administration, or Part B preventive service, an exception MACs implemented on October 5, 2026.
Does the patient need to be homebound for 99342?
No. Medicare doesn’t require homebound status for home or residence E/M visits. The note still needs to show medical necessity for a home visit instead of an office visit. Noridian looks for a chief complaint on each visit, who requested the visit, and visit frequency in line with office care. Medicare treats a visit made for the practitioner’s convenience as a social visit. Status codes such as Z74.09 or Z99.3 help explain the setting.
How often can 99342 be billed?
In most cases, you bill 99342 once per patient for each practitioner or group specialty within a three year window. After the first professional service, later home visits by the same practitioner or another practitioner of the same specialty in the group are established and use 99347 to 99350. A repeat 99342 within three years is a common audit flag. Check claim history before the visit, and confirm the group’s specialty mix if NPs or PAs see the patient.
Bill 99342 Right the First Time
A clean 99342 CPT code claim rests on four checks: new patient status, a residence setting with the matching POS, low MDM or 30 minutes of documented time without travel, and a note that shows why care happened at home. Add G2211 when the visit starts ongoing care, and watch modifier 25.
These rules apply to each CPT code for home visit billing, and a miss on any of them changes what the payer sends back. ClaimMax RCM helps practices bill home and residence visits with fewer denials. If you want a review of your current home visit claims, talk to our billing team.
Sources
- American Medical Association. CPT Evaluation and Management (E/M) Code and Guideline Changes, 2023. https://www.ama-assn.org/system/files/2023-e-m-descriptors-guidelines.pdf
- Centers for Medicare & Medicaid Services. Evaluation and Management Services (MLN006764). https://www.cms.gov/files/document/mln006764-evaluation-management-services.pdf
- Centers for Medicare & Medicaid Services. Physician Fee Schedule Look-Up Tool. https://www.cms.gov/medicare/physician-fee-schedule/search/overview
- Centers for Medicare & Medicaid Services. Transmittal R13753CP, Change Request 14447, May 7, 2026. https://www.cms.gov/files/document/r13753cp.pdf
- Centers for Medicare & Medicaid Services. List of Telehealth Services. https://www.cms.gov/medicare/coverage/telehealth/list-services
- Centers for Medicare & Medicaid Services. RAC Approved Topic 0011. https://www.cms.gov/research-statistics-data-and-systems/monitoring-programs/medicare-ffs-compliance-programs/recovery-audit-program/approved-rac-topics-items/0011-inappropriate-billing-of-home-visit-professional-service-evaulation-and-management-codes-during-inpatient
- Noridian Healthcare Solutions. Home and Domiciliary Visits (JE Part B). https://med.noridianmedicare.com/web/jeb/specialties/em/home-and-domiciliary-visits
- American Academy of Family Physicians. Coding Home Visits. https://www.aafp.org/fpm/blogs/getting-paid/coding-home-visits
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