Evaluation and Management (E/M) Services in the Domiciliary or Rest Home Environment


Current Procedural Terminology (CPT codes) 99334–99337 are used to report evaluation and management (E/M) services in a facility which provides room, board and other personal assistance services, generally on a long-term basis.

These codes are also used to report E/M services in an assisted living facility. The facility’s services do not include a medical component.

CPT code 99334 is used to reflect the domiciliary or rest home visit for the E/M of an established patient, which requires at least two of these three key components:

  • A problem-focused interval history
  • A problem-focused examination
  • Straightforward medical decision-making

This involves counseling and/or coordination of care with other physicians; other qualified health care professionals, agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family's needs.

Example: The staff at ABC Rest Home reports that Mr. Dom has had a temperature of 100.2 for the past three days. He is voiding but feels warm and lethargic. They have been encouraging him to drink his favorite apple juice and water but he only takes a few sips. MD/NPP examined Mr. Dom and ordered a urinalysis. Results were UTI and patient placed on ABT.

Usually, the presenting problem(s) are self-limited or minor. Typically, 15 minutes are spent with the patient and/or family or caregiver.

CPT code 99335 is used to reflect the Domiciliary or rest home visit for the evaluation and management of an established patient, which requires at least two of these three key components:

  • An expanded problem-focused interval history
  • An expanded problem-focused examination
  • Medical decision-making of low complexity

Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs.

Example: Previously, Mr. Dom was diagnosed with a UTI. In this scenario Mr. Dom’s decreased intake has not only led to a UTI but dehydration (expanded problem) which will require ordering ABC IV Therapy Company to infuse ½ liter of D51/2NS.

Usually, the presenting problem(s) are of low to moderate severity. Typically, 25 minutes are spent with the patient and /or family or caregiver.

CPT code 99336 is used to reflect the visit rendered in the Domiciliary or rest home for the E/M of an established patient, which requires at least two of these thee key components:

  • A detailed interval history
  • A detailed examination
  • Medical decision-making of moderate complexity

Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs.

Note: In order to receive credit for an interval history, the provider must document an update on the status of the patient from the last encounter.

Example: Previously, Mr. Dom was diagnosed with a UTI and dehydration. Recent urinalysis and follow-up BMP are WNL (within normal limits). Staff reports that while patient urine is clear and without odor and p.o. intake has improved, he is now complaining of numbness and tingling in his left arm. VSS with only slight elevation of his B/P since last week.

Usually, the presenting problem(s) are of moderate to high severity. Typically, 40 minutes are spent with the patient and/or family or caregiver.

CPT code 99337 is used to reflect the domiciliary or rest home visit for the E/M of an established patient, which requires at least two of these three key components:

  • A comprehensive interval history
  • A comprehensive examination
  • Medical-decision making of moderate to high complexity

Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs.

Example: Mr. Dom was evaluated with portable EKG services performed to determine cause of chest pain. O2 sats 88 percent and portable oxygen ordered at 2L/M. Referral for Home Health services obtained.

Usually, the presenting problem(s) are of moderate to high severity. The patient may be unstable or may have developed a significant new problem requiring immediate physician attention. Typically, 60 minutes are spent with the patient and/or family or caregiver.

Reference: Evaluation and Management(E/M) Visits.





Last Updated: 08/03/2020