What is the standard insurance baseline for CPT 99308?

The standard insurance baseline reimbursement rate is $67.93. This represents the customary allowable amount established across standard fee schedules.

Home/Procedures/Subsequent Nursing Facility Care with Straightforward Level of Medical Decision Making

CPT 99308Medical Service

Subsequent Nursing Facility Care with Straightforward Level of Medical Decision Making

Q: What do doctors typically charge for Subsequent Nursing Facility Care with Straightforward Level of Medical Decision Making?

The nationwide median physician charge for Subsequent Nursing Facility Care with Straightforward Level of Medical Decision Making (CPT 99308) is $134.60. Doctor billed charges vary based on geographic region, setting, and overhead.

Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, at least 15 minutes. Clinical pricing breakdown and utilization metrics across 25,763 practicing doctors nationwide.

$134.60

Peer Median Charge

Gross billed rate

$67.93

Standard Baseline

Customary allowable

2.0x

National Markup

Charge vs baseline

25,763

Active Physicians

Billing this code

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Understanding This Medical Fee

Gross Charge vs Negotiated Payment: The median physician charge for this service is $134.60. However, insured patients almost never pay this full amount directly. Insurers negotiate rates down toward the $67.93 baseline.

Self-Pay & Uninsured Guidance: If you are paying without insurance or out-of-network, request a prompt-pay cash discount. Most medical practices are willing to settle self-pay bills near the customary baseline rate rather than the full gross charge.

Key Questions for Your Doctor's Billing Office:

"Does Dr. [Name] participate in my specific insurance plan network?"
"What is the total self-pay or cash rate for code 99308 if paid upfront?"
"Are there separate facility, anesthesia, or pathology fees associated with this procedure?"