Nursing Home

Billing Information

• Nursing home billing has changed in 2023 and now aligns better with clinic-based office visits. See here for nursing home E&M billing guidance.

• You should still use initial visit codes for the first physician (MD/DO) visit after the patient is admitted to the nursing home or the first physician visit after they are readmitted after a hospitalization. This applies even if the patient is not new to you or new to the family medicine department and is different than determining initial vs established visits in clinic. APPs often do a transitional visit that does not count as the initial visit, which must be completed by a physician.

• Only faculty can use time-based billing. Residents must bill based on E&M guidelines.

• Use Off-Site Visit SmartSet for easy access to these codes.