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September 19, 2018

Who May Report CPT Codes 99304 – 99306 Initial Nursing Facility Care

As noted in MLN Matters Number MM4246 (link below):

First, CR4246 clarifies the policy for the delegation of the initial visit in the NF setting. Remember that the initial visit in both SNFs and NFs is defined as the initial comprehensive assessment visit during which the physician completes a thorough assessment, develops a plan of care and writes or verifies admitting orders for the nursing facility resident. (per the Survey and Certification memorandum (S&C-04-08), dated November 13, 2003)

As of January 1, 2006, CPT codes 99304-99306 (Initial Nursing Facility Care, per day) shall be used to report the initial visit. CPT codes 99301 – 99303 are deleted after 12/31/05.

Only a physician may report 99304-99306 for an initial visit performed in an SNF or NF except for (as explained above) those performed by a qualified NPP in the NF setting who is not employed by the facility and when state law permits.

A readmission to a SNF or NF has the same payment policy requirements as an initial admission in both settings.


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