CPT 99306
Global XXX Active1st nf care high mdm 50
CPT 99306 Billing & Documentation Guide
CPT code 99306 (1st nf care high mdm 50) is classified under E/M with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 3.5, a non-facility practice expense RVU of 2.05, and a malpractice RVU of 0.23, a total non-facility RVU of 5.78 and facility RVU of 4.89. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $197.33, though rates vary from $179.68 to $252.51 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 99306, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify NCCI edits before bundling 99306 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
No global period (E/M and other non-procedural services)
MUE Limit (Medically Unlikely Edits)
Submitting more than 1 units of 99306 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
RVU Breakdown, CPT 99306
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 3.5 | 3.5 |
| Practice Expense RVU | 2.05 | 1.16 |
| Malpractice RVU | 0.23 | 0.23 |
| Total RVU | 5.78 | 4.89 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 99306
State-level averages across all MAC localities. Non-facility rates typically apply to office-based services; facility rates apply to hospital outpatient / inpatient.
| State | Non-Facility | Facility | Range (Non-Fac) | Localities |
|---|---|---|---|---|
| California | $206.28 | $171.1 | $198.05 - $232.62 | 29 |
| Florida | $200.56 | $170.73 | $193.91 - $207.61 | 3 |
| Georgia | $191.6 | $163.24 | $187.14 - $196.05 | 2 |
| Illinois | $198.16 | $169.43 | $191.43 - $204.17 | 4 |
| Michigan | $192.01 | $164.1 | $188.09 - $195.93 | 2 |
| North Carolina | $185.7 | $157.96 | $185.7 - $185.7 | 1 |
| New York | $209.28 | $176.11 | $187.35 - $220.06 | 5 |
| Ohio | $187.16 | $160.02 | $187.16 - $187.16 | 1 |
| Pennsylvania | $193.24 | $164.12 | $187.02 - $199.45 | 2 |
| Texas | $192.09 | $162.83 | $186.35 - $196.4 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
NCCI Bundling Edits, CPT 99306
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 99306 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 0115T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0116T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0359T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0360T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0361T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0362T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0362T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0363T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0364T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0365T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
Frequently Asked Questions, CPT 99306
What does CPT code 99306 mean? +
CPT code 99306 represents: 1st nf care high mdm 50. It's in the E/M category with a global period of XXX.
What is the Medicare reimbursement for CPT 99306? +
The 2026 Medicare national average non-facility payment for CPT 99306 is $197.33. Rates range from $179.68 to $252.51 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 99306? +
E/M codes commonly use modifier 25 (significant separately identifiable E/M on same day as a procedure), 57 (decision for major surgery), 24 (unrelated E/M during global period), 95 (synchronous audio+video telehealth), 93 (audio-only telehealth), and AI (principal physician of record on admission). Surgical modifiers like 50, 51, 59 do not apply to E/M.
What bundling edits apply to CPT 99306? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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