You’re 45 miles from the nearest hospital, seeing a frail elder in a remote clinic. The visit takes 50 minutes, covers 3 active problems, and changes 4 meds. That’s CPT 99306—but only if your note proves it.

In 2025, CPT 99306 (nursing facility visit, high complexity, ~45–60 min) is a lifeline for rural health clinics serving aging populations. Payers like Medicare and BCBS are auditing these hard, demanding clear functional impact in every line.

Here’s exactly how rural providers document 99306-level care—no fluff, no denials.

When 99306 Fits: The Rural Reality Check

Rule of thumb: If you’re managing functional decline (ADLs, mobility, cognition), it’s likely 99306.

5 Must-Have Elements in Your 99306 Progress Note

1. Lead with Functional Status

Start with one sentence tying symptoms to daily life:

“88 y/o with dementia, new inability to transfer from bed to chair x2 days—risk for institutionalization.”

2. Document ADLs/IADLs Explicitly

Use check-box or bullet:

• Bathing: Needs total assist (was mod assist)
• Transfers: Hoist required (was 1-person)
• Continence: New incontinence → UTI rule-out

3. Show High-Risk MDM

Number it for clarity:

1. Problems: Fall risk, polypharmacy, weight loss
2. Data: BMP (AKI), UA pending, MMSE 14/30
3. Risk: Hold donepezil, start PT eval, family meeting

4. Time = Your Safety Net

If MDM is close, document total time:

“50 min: 30 min counseling daughter on hospice vs. rehab, 20 min exam + med reconciliation.”

5. Close with Functional Goals

End with measurable outcomes:

“Goal: Safe transfers with 1-person assist in 7 days. RTC 3d or ED if fall.”

99306 Progress Note Template

S: [Functional complaint x duration]

O: 

- ADLs: [Bathing/Toileting/Dressing/Transfers/Feeding]

- Vitals: [BP, O2, weight trend]

- Exam: [Neuro, MSK, skin]

A/P:

1. [Problem] – [Functional impact]

   • Data: [Labs, consults]

   • Plan: [Meds, therapy, goals]

Time: [XX min total; XX min counseling/coordination]

Rural-Specific Red Flags

Pro Tips for Rural Clinics

• Use your AI scribe: Train it to prompt “ADL status?” on every 99306.
• Batch functional screens: Use Katz ADL or Lawton IADL forms—scan to chart.
• Audit monthly: Pull last 5 99306s. Score 1–5 on functional detail.
• Leverage telehealth: Document “20 min video with caregiver” if in-person impossible.

The Bottom Line

99306 isn’t about time—it’s about functional complexity. Show how the visit changes daily living, and payers pay without pushback.