Evaluation & management · General
Home or residence visit for a new patient with low medical decision making or at least 30 minutes of total time.
- Medicare
- $78.83
- Work RVU
- 1.65
- Global, days
- Region
- General
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 3 cited references ↓
- Place of residence (home, assisted living, group home) and matching place of service code
- Reason for seeing the patient at the residence (not a Medicare requirement, but payers and auditors ask)
- History and exam relevant to the complaint
- Assessment and plan supporting low MDM, or at least 30 minutes of total time
- Coordination with home health or caregivers, if any
Applicable modifiers
Modifiers commonly billed with this code.
Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual
What this code covers
Source · Editorial summary grounded in 3 cited references ↓
99342 reports a visit to a new patient at their home or residence, including assisted living and group homes, with low decision making or at least 30 minutes of total time. Since 2023 the home and domiciliary codes are combined, so the same codes are used for a private home and an assisted living facility.
In orthopedic care this might be an elderly patient in assisted living with a stable chronic joint problem, seen at the residence because transport is a burden.
Homebound status is not a Medicare requirement for physician home visits. Match the place of service to the residence: 12 for a private home, 13 for assisted living, 14 for a group home. A postop check during your global stays in the global, even at the patient's door.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
Work RVU vs. total RVU
The work RVU (1.65) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (2.36) adds practice overhead and malpractice, and is what drives the Medicare payment below.
| Work RVU | 1.65 |
| Practice expense RVU | 0.64 |
| Malpractice RVU | 0.07 |
| Total RVU | 2.36 |
| Medicare national rate | $78.83 |
| Global period | days |
Payment by site of service
Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.
Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026
| Setting | Medicare rate (national) |
|---|---|
Office (PFS non-facility) Procedure performed in physician's office | $78.83 |
Common denial reasons
The recurring reasons claims for CPT 99342 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Place of service does not match a home or residence setting
- Postop visit inside a surgical global period
- MDM or time does not support the level billed
- New patient code used for a patient seen in the office within three years
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 3 cited references ↓
01How much time is required for 99342?
02What place of service is used with 99342?
03Can 99342 be billed for a postop check at home?
Sources & references
Editorial content was developed using the following public sources.
Mira Scribe
Mira Scribe notes the residence type and the time or MDM behind the level, which keeps place of service and code in sync.
See how Mira captures CPT 99342 documentation