CPT Code 99316 Description for Nursing Facility Billing

Before 1998, healthcare providers struggled with billing nursing facility discharge services. No dedicated codes existed to represent the comprehensive work involved, including discharge planning, final examinations, medication reconciliation, and caregiver instructions. Providers used subsequent care codes that created documentation gaps and reimbursement uncertainties.

The American Medical Association solved this by introducing CPT codes 99315 and 99316 specifically for nursing facility discharge day management. However, many medical coders still struggle with proper code selection, documentation requirements, and time calculations that determine when CPT 99316 applies.

This guide clarifies the CPT Code 99316 description, provides selection criteria, documentation best practices, and helps you avoid billing errors that trigger claim denials.

What Is CPT Code 99316?

CPT Code 99316 represents nursing facility discharge day management when the provider spends more than 30 minutes in total time on the date of the encounter.

Official CPT definition:

“Nursing facility discharge management; more than 30 minutes total time on the date of the encounter.“

This code falls within the Evaluation and Management (E/M) section for nursing facility services (codes 99304-99318). The Centers for Medicare & Medicaid Services (CMS) recognizes CPT 99316 as separately billable, provided documentation supports the time threshold.

Services Included in CPT Code 99316

CPT 99316 includes all medically necessary discharge management services performed on the discharge date

Key activities covered:

• Final examination and patient status assessment
• Discussion of treatment outcomes with the patient and family.
• Preparation of discharge records and prescriptions.
• Instructions to caregivers and receiving facilities
• Coordination with home health agencies.
• Medication reconciliation for the post-discharge period.

Providers must document total time spent, even when activities occur at different times throughout the discharge date. This time-based methodology is different from the level-of-service criteria used for other E/M codes.

CPT Codes 99316 Billing & Time Doc Requirements

Code selection between 99315 and 99316 depends entirely on documented time spent on discharge activities.

The Primary Code Selection Rule:

Time is the only document factor when choosing between CPT 99315 and CPT 99316

• CPT Code 99316 applies when the total documented time exceeds 30 minutes on the discharge date.
• CPT Code 99315 applies when the total document time is less than30 minutes on the discharge date

If the documented time exceeds 30 minutes, CPT 99316 must be reported

Counts Time Includes

The AAPC confirms countable time includes:

• Face-to-face discussions with patient and family.
• Review of diagnostic test results.
• Coordination calls with receiving physicians.
• Completion of discharge summary documentation.
• Prescription writing and medication reconciliation.
• Non-face-to-face administrative tasks on discharge day

Date of Service Rule:

CPT 99316 may only be billed on the actual date the patient is discharged from the nursing facility.

• The patient must physically leave the facility.
• Discharge planning performed on earlier dates is not billable under this code.
• Only one discharge code may be billed per discharge event.

Where CPT Code 99316 is Applicable

CPT 99316 applies to the following settings:

• Skilled nursing facilities (SNFs)
• Long-term care facilities.
• Nursing homes.
• Intermediate care facilities.

The code does not apply to hospital discharges, observation unit discharges, or assisted living facility services, which have separate coding requirements.

Time Documentation Best Practices for CPT 99316

The 2023 E/M updates reinforced time-based selection for nursing facility discharge codes. Proper documentation protects against audits.

How to Document Time Correctly

Record start and stop times or document total time: “Total time spent on discharge management: 45 minutes.”

Example Documentation:

• 0900-0920: Final exam and care plan discussion with patient and daughter (20 min)”
• 1030-1045: Discharge summary and medication reconciliation (15 min)
• 1100-1115: Coordination call with home health agency (15 min)
• Total discharge time: 50 minutes. CPT 99316 reported.

Common Documentation Mistakes to Avoid 

• Including time from previous days
• Vague statements like “lengthy discharge planning”
• Missing total time documentation.
• Estimating without actual recorded times.

Professional medical billing services implement time-tracking workflows, ensuring compliant documentation for every discharge.

CPT 99316 vs 99315 Description with Key Differences

• Use CPT 99315 for straightforward discharges with minimal coordination. Typically, straightforward discharges where the patients return home with stable conditions and established follow-up care.
• Select CPT 99316 for complex discharges involving multiple medications, specialist coordination, or detailed caregiver training. The additional time investment justifies the higher-level code and reimbursements.

Related Nursing Facility Codes (99304-99318)

CPT Code 99316 functions within the nursing facility services code family.

Initial Care (99304-99306)

• CPT 99304: Problem-focused initial encounter.
• CPT 99305: Detailed initial encounter.
• CPT 99306: Comprehensive initial encounter.

Subsequent Care (99307-99310)

• CPT 99307: Straightforward subsequent visit
• CPT 99308: Low complexity
• CPT 99309: Moderate complexity
• CPT 99310: High complexity

Annual Assessment

CPT 99318: Required annual assessment for long-term residents

Bundling Rules

CPT 99316 cannot be reported with codes 99304-99310 on the same date. The discharge code encompasses all E/M services provided on the discharge date per CMS guidelines.

Common Billing Mistakes in Nursing Facility Billing (99305-99318)

• Insufficient Time Documentation: The record does not clearly state the total time spent exceeding the 30-minute threshold required for 99316.
• Wrong Date of Service: The discharge service is billed on a date that doesn’t match the actual discharge encounter.
• Incorrect Code Pairing: 99316 is reported together with the same-day subsequent nursing facility care codes, even though discharge services are bundled.
• Missing Medical Necessity: The note doesn’t describe the patient’s clinical status, discharge planning complexity, or discharge destination.

Professional medical billing and coding teams at Hello MDs conduct audits, identifying these patterns. Our advanced RCM healthcare services platforms flag documentation deficiencies during claim scrubbing.

CPT Code 99316 Reimbursement Information

CPT Code 99316 reimbursement varies by payer and geographic location.

Medicare Rates (2026)

• Facility Rate: $117.57
• Non-Facility Rate: $139.51

Actual payment depends on the Medicare Administrative Contractor jurisdiction.

Commercial Payer Rates

Private insurance typically reimburses 110-150% of Medicare rates.

Common Denial Reasons

• Insufficient time documentation
• Missing discharge date confirmation
• Lack of medical necessity
• Bundling edits with same-date services

Expert denial management services at Hello MDs analyze patterns and implement corrective workflows, preventing recurrent issues.

Conclusion

Understanding CPT Code 99316 description ensures nursing facility providers receive appropriate compensation for discharge management services. The time threshold of more than 30 minutes of documented activities on the encounter date distinguishes this code from CPT 99315.

Success with nursing facility billing requires accurate time documentation, proper code selection from CPT codes 99304-99318, and proactive denial prevention. Professional medical billing and coding services at Hello MDs, eliminate documentation gaps and optimize revenue capture.

Partner with us to transform your billing operations and achieve sustainable financial performance across all nursing facility services.

Disclaimer:

This content is provided by Hello MDs for general medical billing and coding education purposes. Actual coding, documentation, and reimbursement may vary by payer, contract, and jurisdiction. Providers and billing teams should confirm all requirements before claim submission. Any images included are AI-generated for illustration purposes only.