CPT 99309
Global XXX ActiveSbsq nf care moderate mdm 30
CPT 99309 Billing & Documentation Guide
CPT code 99309 (Sbsq nf care moderate mdm 30) is classified under E/M with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 1.92, a non-facility practice expense RVU of 1.37, and a malpractice RVU of 0.14, a total non-facility RVU of 3.43 and facility RVU of 2.95. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $117.2, though rates vary from $105.85 to $147.5 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 99309, 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 99309 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 99309 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 99309
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 1.92 | 1.92 |
| Practice Expense RVU | 1.37 | 0.89 |
| Malpractice RVU | 0.14 | 0.14 |
| Total RVU | 3.43 | 2.95 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 99309
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 | $123.11 | $104.14 | $117.88 - $139.68 | 29 |
| Florida | $119.14 | $103.06 | $114.9 - $123.59 | 3 |
| Georgia | $113.48 | $98.18 | $110.52 - $116.43 | 2 |
| Illinois | $117.51 | $102.02 | $113.22 - $121.3 | 4 |
| Michigan | $113.68 | $98.63 | $111.19 - $116.17 | 2 |
| North Carolina | $109.81 | $94.85 | $109.81 - $109.81 | 1 |
| New York | $124.58 | $106.69 | $110.89 - $131.33 | 5 |
| Ohio | $110.62 | $95.98 | $110.62 - $110.62 | 1 |
| Pennsylvania | $114.53 | $98.83 | $110.56 - $118.5 | 2 |
| Texas | $113.88 | $98.09 | $110.11 - $116.81 | 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 99309
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 99309 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 99309
What does CPT code 99309 mean? +
CPT code 99309 represents: Sbsq nf care moderate mdm 30. It's in the E/M category with a global period of XXX.
What is the Medicare reimbursement for CPT 99309? +
The 2026 Medicare national average non-facility payment for CPT 99309 is $117.2. Rates range from $105.85 to $147.5 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 99309? +
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 99309? +
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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