Domiciliary, Home and Residence Service Codes
Note: Deletion of domiciliary or rest home codes 99334–99340. These have been merged with the existing home visit codes 99341–99350. Elimination of duplicate medical decision making (MDM) level new patient code (99343).
Beginning January 1, 2023, the CPT ® is merging the two Evaluation and Management (E/M) visit families currently titled “Domiciliary, Rest Home (e.g., Boarding Home), or Custodial Care Services” and "Home Services." The new family will be titled 'Home or Residence Services." The codes in this family (CPT ® codes 99341–99350) will be used to report E/M services furnished to a patient residing in their home, in an assisted living facility, in a group home (that is not licensed as an intermediate care facility for individuals with intellectual disabilities), in a custodial care facility, or in a residential substance abuse treatment facility.
There are no changes to the included care settings from each respective family, rather the current care settings for each of the current families are being included within the new, merged family. For services in an intermediate care facility for individuals with intellectual disabilities and services provided in a psychiatric residential treatment center, see Nursing Facility Services in Section 30.6.13.
Physicians and qualified nonphysician practitioners (NPPs) furnishing E/M services to residents in a living arrangement described by one of the places of service (POS) listed above must use the level of service code in the CPT ® code range 99341–99350 to report the service they provide.
Any service billed to Medicare must be medically necessary. Chronic and inactive diagnosis/conditions in and of themselves do not constitute medical necessity in any setting (office, rest home, home, etc.).
Medical necessity must exist for each individual visit. A diagnosis alone does not support medical necessity for the visit. Visit frequency should be dictated by medical necessity and addressing the clinical condition and not driven by the site of service or exceed that of an office setting.
Home
Home or residence codes are used to report evaluation and management services provided in a home or residence. Home may be defined as a private residence, temporary lodging, or short-term accommodation (e.g., hotel, campground, hostel, or cruise ship).
These codes are also used when the residence is an assisted living facility, group home (that is not licensed as an intermediate care facility for individuals with intellectual disabilities), custodial care facility, or residential substance abuse treatment facility.
For services in an intermediate care facility for individuals with intellectual disabilities and services provided in a psychiatric residential treatment center (see Nursing Facility Services).
The definition of home has not changed. However, the guideline for this code set has been revised or expanded to include assisted living facility and group home.
Home visits services (CPT ® codes 99341–99350) may only be billed when services are provided in beneficiary's private residence (POS 12). To bill these codes, physician must be physically present in beneficiary's home. There may be circumstances where home health services and services of physician/qualified non-physician practitioners (NPPs) are performed on the same day. These services cannot be duplicative or overlap.
Documentation of E/M services in the home setting must include a chief complaint; history of presenting illness (HPI), review of systems, past, family, and social history. These elements are key components to support medical necessity.
Common Denial Reasons
- Service is provided at a frequency that exceeds that which is typically provided in office and acceptable standards of medical practice
- Services were duplicative or overlapping
- The beneficiary is treated by other providers for the same diagnosis
- The service is not personally performed or ordered by the rendering/billing provider
- The service is not medically necessary
Refer to the CPT ® 2023 manual for complete CPT descriptions.
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