How to bill for a house call visit

More physicians are seeing the benefits of house calls, but at-home visits come with specific reimbursement and practical considerations. Here's a quick overview of tips and CPT codes for the next time you bill for a house call visit.

Consider this when you bill for a house call

Medicare reimburses providers for home visits only if they are medically necessary. Healthcare.gov defines medically necessary services as “services or supplies that are needed to diagnose or treat a medical condition and that meet accepted standards of medical practice.”

In the case of house calls, physicians need to document that the home visit was medically necessary. In other words, you must present a medical rather than practical reason for visiting a patient outside the office.

Here are a few reminders to consider before you bill for a house call:

• Providers need to document if the home visit is based upon a one-time, ongoing, or permanent need.

• Your documentation should prove that the patient is not physically capable of traveling to the office. You may base this assessment on physical or mental issues, not financial or personal matters.

• You can't provide home services for your convenience as the physician.

• Patients receiving care under Medicare’s home health benefit must be confined to the home. However, patients don't need to be home-bound for physicians to provide services billed under CPT codes 99341 through 99350.

The Office of Inspector General (OIG) and many CMS contractors regularly audit home services billed to Medicare. Always provide appropriate documentation showing that the house call was medically necessary.

“In other words, you must present a medical rather than practical reason for visiting a patient outside the office.”

CPT Home Services Codes

Physicians use a limited set of CPT codes to bill for house calls. These codes apply to evaluation and management (E/M) services provided in a patient’s home. “Home” can include a private residence, temporary lodging, or short-term accommodation.

As of 2023, providers should also use these codes to bill for medical services delivered in assisted living facilities and other places where only minimal health care is provided.

New patient CPT codes

99341 - Home visit for the evaluation and management of a new patient. This visit requires the following three components:

1. A problem-focused history

1. A problem-focused exam

1. Straightforward medical decision making

Here’s a typical description for this code:

Counseling and/or coordination of care with other physicians, other qualified health care professionals, or other agencies are provided consistent with the nature of the problem(s) and the patients’ and/or family’s needs.

Usually, the presenting problem(s) are of low severity. Typically, the physician spends 20 minutes face-to-face with the patient and/or family.

99342 - Same as above, but this is a moderate severity problem requiring 30 minutes.

(CPT deleted code 99343 as of January 2023.)

99344 - Moderate to high severity problem, or at least 60 minutes total time.

99345 - Patient unstable or has a significant new problem requiring immediate attention (75 minutes).

Established patient CPT codes

99347 - Home visit for evaluating and managing an established patient. The visit requires at least two of these three key components.

1. A problem-focused interval history

1. A problem-focused examination

1. Straightforward medical decision making

Here’s the typical description for this code:

Counseling and/or coordination of care with other physicians, other qualified health care professionals, or other agencies are provided consistent with the nature of the problem(s) and the patients’ and/or family’s needs.

Usually, the presenting problem(s) are self-limited or minor. Typically, you spend 15 minutes face-to-face with the patient and/or family.

99348 - Same as above, but this problem is low to moderate severity, requiring at least 30 minutes face-to-face.

99349 - Moderate to high problem requiring 40 minutes.

99350 - Patient unstable or has a significant new problem requiring immediate physician attention (60 minutes).

When making a house call, you may offer additional services such as advanced care planning, diagnosis services, or other minor procedures. These can be documented and billed in addition to the visit code.

How to select house call CPT codes

These tips from the AAFP will help you choose the correct codes:

• Select codes based on either your level of medical decision making (straightforward to complex) or the total time of the encounter. This is similar to selecting codes for office visits.

• When the total encounter time exceeds the threshold for code 99345 or 99350 by at least 15 minutes, you can add code 99417 to report prolonged services. However, if you saw a Medicare patient, report prolonged services with code G0318 in addition to 99345 (more details here).

• CPT deleted E/M codes specific to domiciliary, rest home, or custodial care (99324-99238, 99334-99337, 99339, and 99340). For those types of visits, use the codes above instead.

• For services in facilities where significant medical or psychiatric care is available, use codes 99304-99310.

2023 Updates to CPT Codes for House Call Visits

The CPT codes above reflect 2023 updates that combined two previously distinct E/M visit families: “Domiciliary, Rest Home (Boarding Home), or Custodial Care services” and “Home services.” These visit types are now collectively called “Home or Residence services” and are used to report E/M services provided to patients in their home/residence, assisted living facilities, group homes, custodial care facilities, and residential substance abuse treatment facilities.

The care settings for the current code families were not changed. You can learn more about the recent updates in CMS’ Evaluation and Management Services Guide.

House calls: further reading

Here are some recommended articles for those interested in learning more about house calls:

• House calls are making a comeback

• The benefits of house calls for patients and providers

• 7 ways to easily document house calls on the go