CPT 99307

Across 1,476,728 services billed by 8,117 providers to 638,458 beneficiaries, Medicare allowed an average of $38.21 per service. That is 2.3 services per beneficiary, so this is a code patients typically receive more than once. 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.

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.

• 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
• 99306Initial nursing facility care$173.94
• 99350Residence visit for established patient$162.36
• 99305Initial nursing facility care$126.36
• 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

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.

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