99316 Nf dschrg mgmt 30 min+
What 99316 is
CMS fee schedule short descriptor: Nf dschrg mgmt 30 min+.
Full CPT long descriptions are licensed by the American Medical Association and are not published on this site; the short descriptor above is the one CMS prints in its own fee schedule file. See About CPT.
Medicare payment for 99316 (CY2026)
| Work RVU | Practice expense RVU | Malpractice RVU | Total | Medicare rate | |
|---|---|---|---|---|---|
| Non-facility (office) | 2.50 | 1.47 | 0.17 | 4.14 | $138.28 |
| Facility (hospital, ASC) | 2.50 | 0.85 | 0.17 | 3.52 | $117.57 |
National rates: total RVUs x the CY2026 conversion factor of 33.4009 (non-QP), before geographic adjustment. Actual Medicare payment is 80% of the rate shown after the deductible; the patient or secondary payer owes the 20% coinsurance.
Status: Active - payable under the Physician Fee Schedule. Global period: Global concept does not apply.
Medically Unlikely Edit (MUE)
Medicare caps 99316 at 1 unit per date of service for practitioner claims (MAI 2 - date of service edit (absolute): units above the MUE never pay), rationale: Code Descriptor / CPT Instruction. Units above the cap are denied unless the edit's adjudication rules allow an appeal with documentation.
Billed with 99316? These codes are bundled into it
99316 is a Column 1 code in 140 active NCCI PTP edits. When one of these Column 2 codes is reported on the same date of service, it is denied as bundled - unless the edit's modifier indicator is 1 and documentation supports a distinct service with an NCCI-associated modifier.
| Column 2 code | Short description | Modifier indicator | |
|---|---|---|---|
0362T | Bhv id suprt assmt ea 15 min | 1 - modifier may bypass | Check pair |
0373T | Adapt bhv tx ea 15 min | 1 - modifier may bypass | Check pair |
0469T | Rta polarize scan oc scr bi | 0 - no modifier bypass | Check pair |
0569T | Ttvr perq appr 1st prosth | 1 - modifier may bypass | Check pair |
0570T | Ttvr perq ea addl prosth | 1 - modifier may bypass | Check pair |
0571T | Insj/rplcmt icds ss eltrd | 1 - modifier may bypass | Check pair |
0572T | Insertion ss dfb electrode | 1 - modifier may bypass | Check pair |
0573T | Removal ss dfb electrode | 1 - modifier may bypass | Check pair |
0574T | Repos prev ss impl dfb eltrd | 1 - modifier may bypass | Check pair |
0580T | Rmvl ss impl dfb pg only | 1 - modifier may bypass | Check pair |
0581T | Abltj mal brst tum perq crtx | 1 - modifier may bypass | Check pair |
0582T | Trurl abltj mal prst8 tiss | 1 - modifier may bypass | Check pair |
0655T | Tprnl focal abltj mal prst8 | 1 - modifier may bypass | Check pair |
20560 | Ndl insj w/o njx 1 or 2 musc | 1 - modifier may bypass | Check pair |
20561 | Ndl insj w/o njx 3+ musc | 1 - modifier may bypass | Check pair |
20700 | Mnl prep&insj dp rx dlvr dev | 1 - modifier may bypass | Check pair |
20701 | Rmvl deep rx delivery device | 1 - modifier may bypass | Check pair |
36591 | Draw blood off venous device | 0 - no modifier bypass | Check pair |
36592 | Collect blood from picc | 0 - no modifier bypass | Check pair |
43752 | Nasal/orogastric w/tube plmt | 1 - modifier may bypass | Check pair |
51721 | Ins trurl ablt trnsdc thr us | 0 - no modifier bypass | Check pair |
90863 | Pharmacologic mgmt w/psytx | 0 - no modifier bypass | Check pair |
90940 | Hemodialysis access study | 0 - no modifier bypass | Check pair |
92002 | Intrm oph exam new patient | 0 - no modifier bypass | Check pair |
92004 | Compre oph exam new pt 1/> | 0 - no modifier bypass | Check pair |
92012 | Intrm oph exam est patient | 0 - no modifier bypass | Check pair |
92014 | Compre oph exam est pt 1/> | 0 - no modifier bypass | Check pair |
92227 | Img rta detcj/mntr ds staff | 1 - modifier may bypass | Check pair |
92228 | Img rta detc/mntr ds phy/qhp | 1 - modifier may bypass | Check pair |
92531 | Spontaneous nystagmus study | 0 - no modifier bypass | Check pair |
Showing 30 of 140 column 2 codes. Use the pair checker for any specific combination.
99316 is bundled into these codes
99316 appears as a Column 2 code in 5951 active edits. Reported with one of these Column 1 codes on the same date of service, 99316 is the code that denies.
| Column 1 code | Short description | Modifier indicator | |
|---|---|---|---|
00537 | Anes cardiac ep procedures | 0 | Check pair |
00550 | Anes for sternal debridement | 0 | Check pair |
00563 | Anes px heart w/pmp crc arst | 0 | Check pair |
00566 | Anes direct cabg w/o pump | 0 | Check pair |
00625 | Anes thrc spine wo 1lng vent | 0 | Check pair |
00626 | Anes thrc spine w/1 lng vent | 0 | Check pair |
00635 | Anes dx/ther lumbar pnxr | 0 | Check pair |
01112 | Anes bone marrow aspir&/bx | 0 | Check pair |
01173 | Anes opn rpr fx disrpj plvs | 0 | Check pair |
01215 | Anes opn revj tot hip arthrp | 0 | Check pair |
01937 | Anes drg/aspir crv/thrc | 0 | Check pair |
01938 | Anes drg/aspir lmbr/sac | 0 | Check pair |
01939 | Anes nulyt agt crv/thrc | 0 | Check pair |
01940 | Anes nulyt agt lmbr/sac | 0 | Check pair |
01941 | Anes neuromd/ntrvrt crv/thrc | 0 | Check pair |
Data: CMS CY2026 Physician Fee Schedule RVU file (October release, RVU26D) and Medicare NCCI PTP practitioner edits v32.3 (2026 Q4). Verify against the official files before billing or contracting decisions.