CPT® code 99349 is used to report a medically necessary home visit for an established patient that involves a moderate to high level of medical decision-making or requires 40 minutes of total time spent on the day of the encounter. This code allows providers to deliver and bill for in-home care when a patient’s condition makes it difficult to receive services in a traditional office setting.
When to Use CPT® Code 99349
- When a provider performs a medically necessary home visit for an established patient.
- When the visit requires moderate to high complexity in medical decision-making.
- When at least 40 minutes are spent on the day of the encounter, including face-to-face and non-face-to-face time.
- When care is provided in the patient’s residence, not in an institutional setting (e.g., nursing facility).
Billing Requirements
- Documentation must clearly outline the patient’s condition, medical necessity, and the complexity of decision-making.
- Time spent must be recorded to support billing accuracy.
- Only one provider may bill for the same visit; services cannot overlap with facility-based E/M codes.
- Some payers may require prior authorization for recurring home visits.
Common Clinical Scenarios
- A physician visits a homebound patient with advanced heart failure requiring medication adjustments and ongoing monitoring.
- A provider manages a patient with multiple chronic conditions who is unable to travel to the office due to limited mobility.
- A home visit is conducted to evaluate and manage acute issues in an established patient already under chronic disease management.
Streamline Home Visit Documentation with OptiMantra
Billing for services like CPT® 99349 requires detailed documentation of medical necessity, time, and complexity. OptiMantra’s EMR and practice management platform makes it simple to capture visit details, track time, and apply the correct billing codes. Whether your practice provides in-office, telehealth, or home-based visits, OptiMantra ensures compliance while helping you deliver high-quality patient care without administrative headaches.
Try OptiMantra for free here!
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