How much does Medicare pay for CPT 99305?

Medicare allowed an average of $126.36 per service and paid $98.82 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $290.51, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 99305?

Initial nursing facility care with moderate level of medical decision making, per day, if using time, at least 35 minutes. It was billed 1,020,750 times to 939,144 Medicare beneficiaries by 10,676 providers in 2024.

Does 99305 pay differently in an office than a hospital?

Yes. The allowed amount averaged $124.74 in an office setting and $127.00 in a facility. The office rate is generally higher because the practice supplies the room, staff and equipment out of that single payment; in a hospital those are billed separately by the facility.

Which specialty bills 99305 most?

Nurse Practitioner, with 292,620 services from 3,539 clinicians. Next are Internal Medicine, Family Practice, Physical Medicine and Rehabilitation.

CPT 99305

Initial nursing facility care with moderate level of medical decision making, per day, if using time, at least 35 minutes

$126.36Medicare-allowed amount per service, averaged across 1,020,750 services

Providers submitted

$290.51

Asking price, not received

Medicare allowed

$126.36

The fee schedule figure

Medicare paid

$98.82

Balance is patient coinsurance

Providers submitted an average of $290.51 for this code and Medicare allowed $126.36 — 2.3× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $98.82 (78%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $124.74
Hospital / facility: $127.00

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 291,894 services were billed in an office setting and 728,856 in a facility.

Services: 1,020,750
Beneficiaries: 939,144
Providers billing it: 10,676
Total allowed: $128,981,970

What Medicare pays for CPT 99305

Across 1,020,750 services billed by 10,676 providers to 939,144 beneficiaries, Medicare allowed an average of $126.36 per service. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 99305

Specialty	Services	Beneficiaries	Avg allowed	Providers
Nurse Practitioner	292,620	276,793	$113.26	3,539
Internal Medicine	205,090	179,824	$132.07	2,322
Family Practice	140,538	127,394	$129.61	1,679
Physical Medicine and Rehabilitation	107,429	96,744	$136.41	572
Physician Assistant	64,632	61,324	$115.22	568
Podiatry	40,829	39,980	$136.11	372
General Surgery	24,045	22,992	$137.01	191
General Practice	16,575	14,845	$131.43	138
Geriatric Medicine	14,571	13,085	$131.83	181
Infectious Disease	11,993	10,597	$134.27	88
Otolaryngology	11,955	11,745	$137.85	15
Cardiology	11,684	11,105	$137.22	86
Hospitalist	11,549	10,558	$130.00	178
Emergency Medicine	9,762	8,699	$129.77	88
Psychiatry	9,536	9,116	$134.07	119

99305 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
New York	139,973	$135.37	$96.85	954
Florida	123,443	$125.58	$95.90	1,107
California	101,745	$132.35	$97.88	740
New Jersey	79,074	$131.41	$95.59	782
Illinois	72,790	$124.35	$94.99	636
Texas	47,942	$120.74	$95.74	632
Pennsylvania	47,735	$121.96	$94.75	635
Maryland	41,375	$127.53	$94.19	334
Ohio	33,027	$121.80	$96.89	462
Michigan	30,559	$124.97	$96.88	333
Massachusetts	26,640	$129.76	$97.63	259
Indiana	25,683	$116.74	$94.42	311
North Carolina	23,542	$120.18	$96.58	282
Virginia	18,659	$124.10	$94.98	227
Tennessee	17,568	$118.80	$97.24	197
Connecticut	14,897	$129.84	$96.38	220
Georgia	13,962	$119.51	$94.07	165
Missouri	13,808	$119.82	$95.18	208
Kentucky	12,293	$121.76	$98.40	144
Oklahoma	11,591	$117.49	$94.67	121
Washington	11,378	$125.66	$95.83	111
South Carolina	9,619	$121.79	$97.83	131
Alabama	8,131	$120.02	$98.83	109
Arizona	7,879	$121.00	$95.91	112
Kansas	7,282	$116.04	$95.78	83
Minnesota	6,626	$120.47	$94.25	129
Nevada	6,362	$116.82	$92.63	83
Wisconsin	5,817	$122.02	$98.27	114
Iowa	5,656	$119.68	$96.30	94
Delaware	5,589	$124.16	$95.87	36
Louisiana	5,503	$117.61	$94.23	103
West Virginia	5,272	$121.84	$96.03	89
Mississippi	4,758	$118.18	$95.73	110
Arkansas	4,739	$117.03	$95.84	99
Rhode Island	4,646	$120.98	$92.42	47
Colorado	4,005	$130.73	$98.31	83
New Hampshire	3,752	$120.76	$93.25	49
Oregon	2,641	$125.50	$96.55	51
Utah	2,348	$122.15	$93.88	40
Maine	1,509	$118.85	$92.71	25
Idaho	1,477	$115.42	$92.27	35
New Mexico	1,392	$114.34	$90.93	25
Nebraska	1,291	$116.01	$93.95	29
District of Columbia	1,266	$131.69	$94.99	20
North Dakota	944	$124.44	$98.51	19
Hawaii	887	$131.91	$97.95	18
Montana	812	$130.26	$98.62	14
Vermont	801	$120.46	$95.69	19
Wyoming	683	$124.99	$96.79	21
South Dakota	429	$124.98	$98.44	15
Alaska	295	$158.96	$96.79	8
AE	265	$115.38	$86.65	1
XX	183	$120.09	$92.76	2
Northern Mariana Islands	168	$126.87	$101.28	1
Puerto Rico	39	$127.88	$100.70	2

Related codes

99309Subsequent nursing facility care$96.76
99308Subsequent nursing facility care$68.91
99349Residence visit for established patient$111.27
99310Subsequent nursing facility care$136.30
99348Residence visit for established patient$69.57
99307Subsequent nursing facility care$38.21
99306Initial nursing facility care$173.94
99350Residence visit for established patient$162.36
99347Residence visit for established patient$42.71
99316Nursing facility discharge management$116.89
99304Initial nursing facility care$76.99
99344Residence visit for new patient$127.50

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.