Nursing home and skilled nursing facility billing uses a specific set of CPT codes for nursing facility E/M services, primarily 99304–99310 for initial and subsequent care and 99315–99316 for discharge day management. Medicare also recognizes HCPCS G0317 for prolonged nursing facility E/M services when applicable.
For 2026, accurate nursing facility billing depends on more than selecting the right CPT code. Providers and billing teams must also verify medical decision making (MDM), total time when time is used, place of service (POS), Medicare Part A status, modifier requirements, and supporting documentation.
Nursing Home CPT Codes 2026: Overview
| CPT Code | Service | MDM Level | Time-Based Threshold |
|---|---|---|---|
| 99304 | Initial nursing facility care | Straightforward/Low | 25+ min |
| 99305 | Initial nursing facility care | Moderate | 35+ min |
| 99306 | Initial nursing facility care | High | 50+ min |
| 99307 | Subsequent nursing facility care | Straightforward | 10+ min |
| 99308 | Subsequent nursing facility care | Low | 20+ min |
| 99309 | Subsequent nursing facility care | Moderate | 30+ min |
| 99310 | Subsequent nursing facility care | High | 45+ min |
| 99315 | Nursing facility discharge | Time-based | 30 min or less |
| 99316 | Nursing facility discharge | Time-based | More than 30 min |
CMS’s current Medicare data describes 99304 at 25 minutes, 99305 at 35 minutes, 99306 at 50 minutes, 99307 at 10 minutes, 99308 at 20 minutes, 99309 at 30 minutes, and 99310 at 45 minutes when time is used for code selection.
Important: These are meet-or-exceed time thresholds, not simply ranges that automatically determine the code. MDM can be used instead when permitted by the code family and documentation supports the selected level.
Are Nursing Home CPT Codes Billed to Part A or Part B?
Nursing facility E/M CPT codes are generally professional services billed to Medicare Part B, while the SNF bills its covered facility services separately under Medicare Part A.
Key points:
- Physician services: Billed under Part B using the appropriate nursing facility E/M CPT code.
- SNF facility services: Covered facility services are billed separately under Part A.
- Separate billing: The physician and facility may bill for the same patient and date of service under their respective payment systems.
- Part A SNF coverage: Generally requires a qualifying inpatient hospital stay, timely SNF admission, and a need for daily skilled care that is reasonable and necessary.
Important: Medicare’s SNF consolidated billing rules include specific exclusions for certain professional services, so providers and medical coding services should verify the applicable CMS and payer requirements before billing.
Initial Nursing Facility Care
| CPT | When Used | MDM | Time |
|---|---|---|---|
| 99304 | Initial nursing facility E/M | Straightforward/Low | 25+ min |
| 99305 | Initial nursing facility E/M | Moderate | 35+ min |
| 99306 | Initial nursing facility E/M | High | 50+ min |
Documentation focus: Document the problems addressed, relevant data reviewed or analyzed, management decisions, risk, and total time when time is used to select the code.
Initial nursing facility codes are used for the initial nursing facility E/M service. The three levels are differentiated by the complexity of MDM or, when selecting the level by time, the total time associated with the service.
CPT 99304
99304 represents initial nursing facility care with straightforward or low-level MDM. When selected based on time, the encounter requires at least 25 minutes. Documentation should identify the problems evaluated or managed, relevant information reviewed, and the management decisions made during the encounter.
CPT 99305
99305 represents initial nursing facility care with moderate-level MDM. When selected by time, the threshold is at least 35 minutes. A strong 99305 note should make the clinical complexity visible rather than simply documenting that the resident was admitted and the care plan was reviewed.
For example, documentation may describe management of multiple active conditions, review of clinically relevant records or test results, medication management, and coordination of care.
CPT 99306
99306 represents initial nursing facility care with high-level MDM. When selected by time, the current threshold is 50 minutes or more. This is an important correction to many online nursing home CPT code charts that still list 45 minutes. High-complexity documentation should clearly support the problems addressed, data reviewed or analyzed, and the level of risk associated with management.
For Medicare claims, the principal physician of record reports modifier AI with the initial nursing facility care code when applicable. CMS guidance identifies modifier AI as the identifier for the physician who oversees the patient’s care as the principal physician of record.
Subsequent Nursing Facility Care
Subsequent nursing facility E/M services are reported with 99307, 99308, 99309, or 99310. These codes are reported per day and selected according to the applicable MDM level or total time.
| CPT | MDM Level | Time Threshold | Typical Documentation Focus |
|---|---|---|---|
| 99307 | Straightforward | 10+ min | Stable problems and routine management |
| 99308 | Low | 20+ min | Chronic condition management and low-risk decisions |
| 99309 | Moderate | 30+ min | Multiple conditions, medication management, moderate-risk decisions |
| 99310 | High | 45+ min | Acute deterioration, high-risk treatment decisions, complex management |
CPT 99307
99307 represents subsequent nursing facility care with straightforward MDM. The time threshold is 10 minutes or more. Use documentation that explains what was evaluated or managed and why the service was medically necessary.
CPT 99308
99308 represents subsequent nursing facility care with low-level MDM. When selected using time, the threshold is 20 minutes or more. This is another code frequently misrepresented in older online coding charts. A 15-minute threshold should not be used as the current Medicare reference for 99308.
CPT 99309
99309 represents subsequent nursing facility care with moderate-level MDM or at least 30 minutes when time is used. The record should demonstrate the conditions addressed, relevant data reviewed or analyzed, and management risk supporting moderate MDM.
CPT 99310
99310 represents subsequent nursing facility care with high-level MDM or at least 45 minutes when selected by time. Examples may include management involving significant clinical risk, complex medication decisions, acute deterioration, or other high-risk treatment decisions.
The documentation should support why the encounter reached the high-MDM level rather than relying on phrases such as “patient stable” or “continue current treatment.”
Nursing Facility Discharge Codes
| CPT | Service | Time Requirement |
|---|---|---|
| 99315 | Discharge day management | 30 minutes or less |
| 99316 | Discharge day management | More than 30 minutes |
Nursing facility discharge day management uses:
- 99315: 30 minutes or less
- 99316: More than 30 minutes
Unlike the initial and subsequent nursing facility codes, these discharge codes are time-based.
Documentation should support the discharge management work performed, such as:
- Final patient evaluation
- Discharge instructions
- Medication or prescription planning
- Communication with the patient, family, or caregivers
- Referral and follow-up arrangements
- Preparation of discharge documentation
- Coordination of post-discharge care
CMS guidance specifically identifies 99315–99316 for SNF/NF discharge services.
What Happened to CPT 99318?
CPT 99318 was deleted effective January 1, 2023. It should not be used for annual nursing facility assessments in 2026. Annual assessments are reported using the applicable subsequent nursing facility codes 99307–99310, based on the appropriate coding methodology.
This is an important EHR and charge-master cleanup item. Old superbills, templates, automated charge rules, and coding references should be checked for the deleted 99318 code.
Nursing Facility Modifiers: What Should Billers Check?
| Modifier | Purpose | When to Check |
|---|---|---|
| AI | Identifies the principal physician of record | Initial nursing facility care for Medicare |
| 95 | Synchronous audio-video telehealth | When applicable under payer policy |
| 93 | Synchronous audio-only telehealth | When applicable under payer policy |
| GP | Physical therapy discipline modifier | Part B therapy claims |
| GO | Occupational therapy discipline modifier | Part B therapy claims |
| GN | Speech-language pathology discipline modifier | Part B therapy claims |
Modifier selection depends on the circumstances of the service and payer rules.
Modifier AI: Principal Physician of Record
For Medicare initial nursing facility care, modifier AI identifies the principal physician of record. CMS specifically instructs that only the principal physician of record should append AI when multiple physicians are involved in the patient’s care.
Telehealth Modifiers
For Medicare telehealth, applicable claims may require modifier 95 for synchronous audio-video services, while payer-specific policies determine whether other telehealth modifiers apply.
CMS states that beginning January 1, 2026, Medicare permanently removed frequency limitations for subsequent nursing facility telehealth visits.
The appropriate telehealth place of service code is generally POS 02 or POS 10, depending on where the patient is located for the telehealth service.
Always verify payer-specific telehealth billing requirements before submission.
Place of Service Codes (POS)
Place of service is a critical part of nursing facility claim accuracy. CMS identifies nursing facility E/M codes as applicable to:
| POS | Setting | Nursing Facility Billing Consideration |
|---|---|---|
| 31 | Skilled Nursing Facility | Generally used for covered SNF Part A stays |
| 32 | Nursing Facility | Generally used for nursing facility services outside a covered Part A SNF stay |
| 54 | Intermediate Care Facility for Individuals with Intellectual Disabilities | Included in the nursing facility E/M code family |
| 56 | Psychiatric Residential Treatment Center | Included in the nursing facility E/M code family |
| 11 | Office | Not the normal POS for a nursing facility visit |
| 02 | Telehealth | Used when applicable for telehealth |
| 10 | Telehealth | Used when patient is at home, when applicable |
CMS’s Medicare Claims Processing Manual specifically identifies these four POS codes for nursing facility E/M services. For Medicare billing, POS 31 generally applies when the resident is receiving covered SNF services under a Part A stay, while POS 32 applies to nursing facility services outside a covered Part A SNF stay, subject to the applicable Medicare rules.
Do not automatically use POS 11 simply because the physician normally practices in an office. The POS should reflect where the patient received the service.
Prolonged Nursing Facility Services
Medicare uses HCPCS G0317 for prolonged nursing facility E/M services. G0317 is reported in addition to qualifying nursing facility E/M services when the primary service has been selected using time. It is associated with 99306 and 99310 and is reported in 15-minute increments under Medicare’s prolonged-service methodology.
| Base CPT | Base Time Threshold | Medicare Prolonged Service | Medicare Threshold |
|---|---|---|---|
| 99306 | 50+ min | G0317 | 95+ min |
| 99310 | 45+ min | G0317 | 85+ min |
Important: G0317 is a Medicare HCPCS code for qualifying prolonged nursing facility E/M services. Check the current CMS requirements before billing.
CMS’s prolonged-service methodology counts qualifying physician or qualified practitioner time across the applicable nursing facility service window, which includes the day before the visit, the date of the visit, and the three calendar days after.
Because prolonged-service rules are payer-specific, do not substitute another prolonged E/M code without checking the applicable Medicare or commercial payer policy.
Documentation Checklist for Nursing Home CPT Coding
A defensible nursing facility E/M note should make the following elements clear:
- Medical necessity: Explain why the resident required evaluation or management.
- Problems addressed: Identify the conditions actually evaluated or managed during the encounter.
- Data reviewed or analyzed: Document relevant records, test results, medication information, or other data considered when applicable.
- Risk and management decisions: Show the treatment decisions, medication management, monitoring, or other risks supporting the MDM level.
- Time, when used: Document the total time required under the applicable E/M rules when selecting the code by time.
- Service date: Ensure the date of service matches the actual encounter and billing record.
- Place of service: Verify POS 31, 32, 54, or 56 as applicable before claim submission.
- Modifier requirements: Check AI and any applicable telehealth or payer-specific modifiers.
The goal is not to make the note longer. The goal is to make the clinical work and decision-making identifiable.
2026 Nursing Facility Billing Updates to Know
- Medicare telehealth frequency limits removed
- CMS permanently removed frequency limitations for subsequent nursing facility visits furnished through Medicare telehealth, effective January 1, 2026.
- Medical necessity and other Medicare telehealth requirements still apply.
- FY 2027 SNF PPS changes begin October 1, 2026
- CMS finalized the FY 2027 SNF Prospective Payment System rule (CMS-1843-F) on July 29, 2026.
- The rule includes a 2.4% SNF PPS payment update, based on a 3.3% market basket update minus a 0.9 percentage-point productivity adjustment.
- It also includes changes related to SNF quality reporting and value-based purchasing.
- These changes primarily affect SNF facility payment and reporting, not the physician’s selection of professional nursing facility E/M CPT codes.
The most important 2026 billing lesson is simple: do not select a nursing facility CPT code from the code number alone. Verify the applicable MDM or time requirements, document the work performed, confirm the correct place of service, and check Medicare Part A status and modifier requirements before the claim leaves the billing system.
Because CPT descriptors and Medicare payment policies can change, practices should verify the current CPT codebook, CMS Medicare Claims Processing Manual, Physician Fee Schedule, and applicable MAC/payer guidance before changing their charge master or billing rules.
