CPT 99308 reports a subsequent nursing facility visit, per day, for a resident who needs a medically appropriate history and/or examination and a low level of medical decision making (MDM), or at least 20 minutes of total practitioner time on the date of the encounter.
It is the second of four subsequent-visit levels (99307 to 99310) used after the resident’s initial nursing facility visit. Since the 2023 E/M revision, the level is chosen by MDM or total time, the same way office visits are leveled, and history and exam no longer set the code.
Do not use 99308 for a discharge. Nursing facility discharge day management has its own codes: 99315 (30 minutes or less) and 99316 (more than 30 minutes). Billing 99308 on the day you discharge the resident misreports the service.
This guide covers where 99308 sits in the nursing facility code family, what supports low MDM, how time is counted, the place of service rules, the same-day limits and the documentation a reviewer expects to see. For wider coding rules in older patients, see our geriatrics billing guidelines.
Key Takeaways
- 99308 is a subsequent nursing facility visit with low MDM or 20 or more minutes of total time on the date of service.
- Initial visits use 99304 to 99306. Discharge day uses 99315 or 99316. Neither is reported as 99308.
- The code applies in a skilled nursing facility (POS 31) or a nursing facility (POS 32). Assisted living and other residential settings use the home or residence codes 99347 to 99350.
- Report one subsequent visit per resident per day for the same practitioner, or for practitioners of the same specialty in the same group.
- Time is total time on the date of the visit, on and off the unit. Start and stop times are not required.
The Nursing Facility E/M Code Family
Pick the code by the type of visit first, then by level. The time thresholds below come from the current CPT code descriptors and must be met or exceeded when you level by time.
| CPT code | Visit type | MDM level | Time threshold |
|---|---|---|---|
| 99304 | Initial nursing facility care | Straightforward or low | 25 minutes |
| 99305 | Initial nursing facility care | Moderate | 35 minutes |
| 99306 | Initial nursing facility care | High | 50 minutes |
| 99307 | Subsequent nursing facility care | Straightforward | 10 minutes |
| 99308 | Subsequent nursing facility care | Low | 20 minutes |
| 99309 | Subsequent nursing facility care | Moderate | 30 minutes |
| 99310 | Subsequent nursing facility care | High | 45 minutes |
| 99315 | Nursing facility discharge management | Time-based | 30 minutes or less |
| 99316 | Nursing facility discharge management | Time-based | More than 30 minutes |
Codes that no longer exist. The annual nursing facility assessment code 99318 and the domiciliary and rest home codes 99324 to 99337 were deleted in 2023. Annual assessments are now leveled with 99307 to 99310, and domiciliary visits moved to the home or residence codes.
What Supports Low MDM for 99308
MDM has three elements: the problems addressed, the data reviewed and analyzed, and the risk of patient management. A visit reaches low MDM when it meets or exceeds the low level in two of the three.
| MDM element | What counts as low | Nursing facility example |
|---|---|---|
| Problems addressed | One stable chronic illness, one acute uncomplicated illness or injury, one stable acute illness, or two or more self-limited problems | Routine follow-up of well-controlled hypothyroidism |
| Data | Limited: two items such as reviewing a unique test result, ordering a unique test or reviewing external notes, or an assessment that needs an independent historian | Reviewing a basic metabolic panel and ordering a repeat |
| Risk | Low risk of morbidity from additional testing or treatment | Adjusting a bowel regimen, continuing current therapy |
When the practitioner manages prescription drug therapy, treats a chronic illness with exacerbation or manages two or more stable chronic illnesses, the visit usually moves to 99309. Office-setting examples of the same MDM levels are in our 99213 guide and 99214 guide.
Leveling 99308 by Time
When time is used, count the practitioner’s total time on the date of the visit. That includes reviewing the chart and nursing notes on the unit, examining the resident, talking with family or facility staff, ordering tests and documenting. Time spent by facility nursing staff does not count, and time from other dates does not carry over.
- Document the total minutes and the activities that filled them.
- Start and stop times are not required under CPT time rules.
- 20 to 29 minutes supports 99308; 30 minutes or more supports 99309.
- Prolonged services add-ons apply only after the highest-level codes (99306 and 99310), so they are never billed with 99308.
Place of Service and Setting Rules
| Setting | POS | Codes to use |
|---|---|---|
| Skilled nursing facility | 31 | 99304 to 99310, 99315, 99316 |
| Nursing facility (long-term care) | 32 | 99304 to 99310, 99315, 99316 |
| Assisted living facility | 13 | Home or residence codes 99347 to 99350 |
| Custodial care facility | 33 | Home or residence codes 99347 to 99350 |
Medicare pays the professional service at the facility rate in a SNF (POS 31) and at the non-facility rate in a nursing facility (POS 32), so the POS on the claim changes the allowed amount. Check your exact 2026 amount in the CMS Physician Fee Schedule Look-Up Tool for your locality.
Same-Day and Frequency Limits
- One subsequent visit per day. Multiple short visits by the same practitioner on one date are combined and leveled as one service.
- Not with an initial visit. On the day of the first nursing facility visit, report 99304 to 99306 instead.
- Not on discharge day. The same practitioner reports 99315 or 99316, which include the final exam and discharge work.
- Check medical necessity for routine visits. Medicare requires a reason for each visit. Regularly scheduled visits without a documented clinical need are a common audit finding.
- Follow Medicare visit rules for Part A stays. In a SNF, the initial comprehensive visit has specific physician requirements, while nurse practitioners and physician assistants may perform subsequent visits within state scope of practice.
Modifiers Used With 99308
| Modifier | Use with 99308 when |
|---|---|
| 25 | A significant, separately identifiable E/M is performed on the same day as a minor procedure |
| GV | The attending physician, not employed by the hospice, treats a hospice patient for the terminal condition |
| GW | The service is not related to the hospice patient’s terminal condition |
| 95 or 93 | The visit is furnished by audio-video or audio-only telehealth, when the payer covers it; check the current Medicare telehealth list and rules |
Modifier AI identifies the principal physician of record and belongs on the initial visit (99304 to 99306), not on 99308.
Documentation Checklist for 99308
- The reason for the visit: the problem being followed, a change reported by nursing staff or a scheduled reassessment with a clinical purpose.
- Interval history and a medically appropriate exam.
- Data reviewed or ordered, such as labs, nursing notes or outside records.
- Assessment and plan that show the MDM, including any medication changes.
- Total time and activities, when time is used to select the level.
- A diagnosis that supports the visit; a mismatch can return as a CO-11 denial.
Worked Example
Scenario. A nurse practitioner sees a long-term care resident (POS 32) for follow-up of stable hypertension. She reviews the last two weeks of blood pressure logs and a recent basic metabolic panel, continues the current medication without change and documents 22 minutes of total time. Code: 99308. One stable chronic illness, limited data and low-risk management support low MDM, and 22 minutes independently meets the 20-minute threshold.
Leveling nursing facility visits across several facilities and providers? Steady Medical Billing audits post-acute E/M documentation and catches discharge, POS and same-day errors before claims are sent.
Frequently Asked Questions
What is CPT code 99308?
CPT 99308 is a subsequent nursing facility visit, per day, requiring a medically appropriate history and/or exam and low medical decision making, or at least 20 minutes of total practitioner time on the date of the encounter.
Is 99308 a discharge code?
No. Nursing facility discharge day management is reported with 99315 for 30 minutes or less, or 99316 for more than 30 minutes. 99308 is a subsequent care visit.
What is the difference between 99308 and 99309?
99308 needs low MDM or at least 20 minutes. 99309 needs moderate MDM or at least 30 minutes, which is common when prescription drug therapy is managed.
Can 99308 be billed in assisted living?
No. Assisted living and other residential settings use the home or residence visit codes 99347 to 99350. 99308 is for skilled nursing facilities (POS 31) and nursing facilities (POS 32).
Do I need start and stop times for 99308?
No. When leveling by time, document the total minutes spent on the date of the visit and the activities performed. Start and stop times are not required.
