What is the standard insurance baseline for CPT 99349?

The standard insurance baseline reimbursement rate is $108.34. This represents the customary allowable amount established across standard fee schedules.

Home/Procedures/Residence Visit for Established Patient with Moderate Level of Medical Decision Making

CPT 99349Medical Service

Residence Visit for Established Patient with Moderate Level of Medical Decision Making

Q: What do doctors typically charge for Residence Visit for Established Patient with Moderate Level of Medical Decision Making?

The nationwide median physician charge for Residence Visit for Established Patient with Moderate Level of Medical Decision Making (CPT 99349) is $205.00. Doctor billed charges vary based on geographic region, setting, and overhead.

Residence visit for established patient with moderate level of medical decision making, per day, if using time, at least 40 minutes. Clinical pricing breakdown and utilization metrics across 14,284 practicing doctors nationwide.

$205.00

Peer Median Charge

Gross billed rate

$108.34

Standard Baseline

Customary allowable

1.9x

National Markup

Charge vs baseline

14,284

Active Physicians

Billing this code

Planning care or already received a bill for CPT 99349?Calculate total facility bundle costs or generate an assertive dispute settlement offer.

Calculate Bundled Cost →Dispute an Inflated Bill 🧾

Understanding This Medical Fee

Gross Charge vs Negotiated Payment: The median physician charge for this service is $205.00. However, insured patients almost never pay this full amount directly. Insurers negotiate rates down toward the $108.34 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 99349 if paid upfront?"
"Are there separate facility, anesthesia, or pathology fees associated with this procedure?"