CPT 99310
Global XXX ActiveSbsq nf care high mdm 45
CPT 99310 Billing & Documentation Guide
CPT code 99310 (Sbsq nf care high mdm 45) is classified under E/M with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 2.8, a non-facility practice expense RVU of 1.88, and a malpractice RVU of 0.21, a total non-facility RVU of 4.89 and facility RVU of 4.2. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $166.97, though rates vary from $151.07 to $211.02 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 99310, 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 99310 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 99310 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 99310
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 2.8 | 2.8 |
| Practice Expense RVU | 1.88 | 1.19 |
| Malpractice RVU | 0.21 | 0.21 |
| Total RVU | 4.89 | 4.2 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 99310
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 | $174.98 | $147.71 | $167.69 - $198.12 | 29 |
| Florida | $170.18 | $147.06 | $164.1 - $176.63 | 3 |
| Georgia | $161.97 | $139.98 | $157.9 - $166.03 | 2 |
| Illinois | $167.93 | $145.66 | $161.82 - $173.38 | 4 |
| Michigan | $162.36 | $140.71 | $158.77 - $165.94 | 2 |
| North Carolina | $156.59 | $135.09 | $156.59 - $156.59 | 1 |
| New York | $177.55 | $151.83 | $158.11 - $187.2 | 5 |
| Ohio | $157.92 | $136.88 | $157.92 - $157.92 | 1 |
| Pennsylvania | $163.37 | $140.8 | $157.8 - $168.94 | 2 |
| Texas | $162.37 | $139.68 | $157.18 - $166.36 | 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 99310
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 99310 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 99310
What does CPT code 99310 mean? +
CPT code 99310 represents: Sbsq nf care high mdm 45. It's in the E/M category with a global period of XXX.
What is the Medicare reimbursement for CPT 99310? +
The 2026 Medicare national average non-facility payment for CPT 99310 is $166.97. Rates range from $151.07 to $211.02 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 99310? +
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 99310? +
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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