CPT 92950 Cardiopulmonary Resuscitation Benchmarks

CPT code 92950 represents cardiopulmonary resuscitation (CPR), a life-saving procedure performed during cardiac arrest. This code is essential for documenting and billing emergency interventions that restore cardiac and respiratory function in critical situations. Nationally, the use of CPT code 92950 is relevant across a range of healthcare settings, particularly in emergency departments and inpatient hospital environments, where rapid response is crucial.

Major payers covering this code include Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare. The publication provides an overview of payer coverage, clinical context, and policy updates related to CPT code 92950. Readers will gain insights into typical sites of service, associated physician specialties, and relevant ICD-10 diagnoses. The summary also highlights common billing modifiers and related CPT codes, offering a comprehensive perspective on how CPR is documented and reimbursed in the U.S. healthcare system.

This article is designed for healthcare professionals, billing specialists, and policy analysts seeking up-to-date information on cardiopulmonary resuscitation coding, payer coverage, and clinical benchmarks. It serves as a resource for understanding the national landscape of emergency cardiovascular procedures and their impact on patient care and reimbursement.

CPT Code Overview

CPT code 92950 is used to report cardiopulmonary resuscitation procedures, typically performed in cases of cardiac arrest. This code falls under therapeutic cardiovascular services and procedures, reflecting its critical role in emergency medical care. The service is most commonly provided in the emergency department or inpatient hospital setting (place of service codes 21 or 22), where immediate intervention is required to restore cardiac and respiratory function.

Clinical Context

A patient is brought to the emergency department or is already admitted to the hospital and experiences sudden cardiac arrest. The clinical team, which may include an emergency medicine physician, cardiovascular disease physician, or internal medicine physician, initiates cardiopulmonary resuscitation (CPR) to restore circulation and breathing. The procedure is performed urgently, often in a high-acuity setting such as the emergency department (Place of Service 22) or inpatient hospital (Place of Service 21). The workflow involves immediate assessment, initiation of CPR, and ongoing critical care management as indicated by the patient's response.

Coding Specifications

Modifier 26: Used to indicate the professional component of the service, typically when the physician provides only the interpretation and management, not the technical aspect.
Modifier 59: Used to denote a distinct procedural service, indicating that CPR was performed separately from other procedures or services during the same encounter.

Provider Taxonomy Code	Specialty
`207P00000X`

Medicare's national mean rate for CPT code 92950 is $391.81, which is higher than the BUCA (average commercial) mean rate of $359.82. Among commercial payers, UnitedHealth Group has the highest mean rate at $469.13, while Aetna is the lowest at $302.72.

Rate dispersion, measured by the difference between the 75th and 25th percentiles, varies significantly across payers. Medicare shows the tightest range at $37.00, indicating relatively consistent reimbursement. In contrast, UnitedHealth Group exhibits the widest range at $262.33, reflecting greater variability in rates. Cigna also has a broad range of $224.50, while Aetna and Blue Cross Blue Shield are more moderate.

The table and chart below present a detailed breakdown of national benchmarks for each payer, including mean rates and percentile values.

Related Diagnoses

I46.9: Cardiac arrest, cause unspecified
- Used when the patient experiences cardiac arrest and the underlying cause is not determined at the time of resuscitation.
I46.2: Cardiac arrest due to underlying cardiac condition
- Applied when cardiac arrest is attributed to a known cardiac disease or condition.
I49.9: Cardiac arrhythmia, unspecified
- Relevant when the cardiac arrest is associated with an arrhythmia, but the specific type is not identified.
R09.2: Respiratory arrest
- Used if the patient experiences cessation of breathing, which may necessitate CPR.
R57.9: Shock, unspecified
- Indicates a state of circulatory failure that may lead to cardiac arrest and require resuscitation.

Related CPT Codes

99291: Critical care, evaluation and management of the critically ill or critically injured patient; first 30–74 minutes

99291 is often used in conjunction with 92950 when the patient requires ongoing critical care management following cardiopulmonary resuscitation. While 92950 documents the CPR procedure itself, 99291 captures the time and expertise involved in managing the patient's critical condition. These codes may be used together in the clinical workflow, but each represents a distinct service.

The table and chart below present a detailed breakdown of national benchmarks for each payer, including mean rates and percentile values.

OpenPayer

Summary & Overview

CPT 92950: Cardiopulmonary Resuscitation in Cardiac Arrest