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    v1.0.30
    OpenPayerBilling CodesCritical Care ServicesCPT cpt-99292-critical-care-add-on-30-minute-interval
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    CPT 99292: Critical care, each additional 30 minutes

    Medicare pays $137 and commercial payers pay $186 on average nationally for this procedure.

    CPT code 99292 describes an add-on critical care service for each additional 30 minutes of direct treatment provided after the initial 30–74 minutes, applicable when the patient requires high-intensity management of life‑threatening conditions or vital organ failure; service type is critical care evaluation and management, and the typical site of service is a critical care area such as an intensive care unit (ICU), coronary care unit (CCU), respiratory care unit, or emergency department when care meets critical care criteria.

    For related coverage guidance, see recent payer policy updates: Automated Ambulatory Blood Pressure Monitoring for Diagnosis of Hypertension in Patients with Elevated Office Blood Pressure, Cardiology - Ivabradine, Cardiac Computed Tomography (CCT)/Coronary Computed Tomographic Angiography (CCTA).

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    National Reimbursement Benchmarks

    Nationally, Medicare’s mean allowed rate of $137.3 for CPT 99292 sits well below BUCA’s average commercial mean of $185.8, creating a gap of $48.5 between a common public payer benchmark and a representative commercial composite. This spread highlights that commercial payers on average reimburse notably higher than Medicare for this critical critical care add-on code, with BUCA aligning closer to other large commercial plans than to Medicare.

    Rate dispersion measured by the interquartile range (P75 minus P25) varies across payers. Blue Cross Blue Shield shows a tight IQR of $71.0 ($182.5−$115.4), while Aetna and UnitedHealth Group present wider spreads of $223.4 ($312.6−$90.2) and $102.3 ($224.7−$120.4) respectively; Cigna’s IQR is $98.5 ($213.7−$115.2). BUCA’s IQR is $104.1 ($216.4−$112.3) and Medicare’s IQR is $11.0 ($142−$131), making Medicare the tightest and Aetna the widest in interquartile dispersion.

    National Payer Mean Reimbursement Rates

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    State Reimbursement Rates

    State: Alaska1 / 51

    Rate by payer

    Clinical & Coding Specifications

    Clinical Context

    A 68-year-old male is admitted to the intensive care unit after an out-of-hospital cardiac arrest with return of spontaneous circulation. On arrival he is intubated and mechanically ventilated, remains hypotensive requiring vasopressor support, and has signs of evolving multi-organ dysfunction with rising lactate and oliguria. The emergency medicine and critical care teams perform an initial critical care evaluation and management for 45 minutes, documented under 99291. The patient then requires continued direct critical care beyond the initial period for ongoing ventilator management, titration of vasopressors, frequent arterial blood gas assessments, bedside echocardiography review, and coordination of bedside procedures and consultations over an additional 60 minutes. These subsequent 60 minutes of continuous, direct critical care are reported using 99292 as an add-on to the primary critical care code. Documentation includes time-based start and stop times, details of physiologic instability, specific interventions (intubation settings, vasopressor doses, invasive monitoring), and rationale for continued critical care level services. Typical workflow: initial stabilization and documentation of first 30–74 minutes billed with 99291; when cumulative direct critical care time exceeds the first period, add increments of 99292 for each additional 30 minutes, ensuring medical necessity and that care was directly provided by the reporting clinician. Typical care setting is an intensive care unit (ICU), coronary care unit (CCU), respiratory care unit, or emergency department when critical illness requires intensive monitoring and interventions.

    Related CPT Codes

    CPT CodeDescription

    Related Modifiers

    9 rows

    ModifierDescriptionWhen to Use
    25CPT modifier 25 indicates that on the same day as another procedure or service, the same physician or other qualified health care professional provided a significant, separately identifiable…- When to apply: Use modifier 25 only on an E/M code to indicate the same provider delivered a significant, separately identifiable E/M service on the same day as another procedure or service — i.e.,…
    26Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
    59Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
    80CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…
    95Modifier 95 indicates that a service was provided via synchronous, real‑time audio‑video telehealth rather than in‑person. Per CMS, AAPC and professional associations, append modifier 95 to claim…- Use modifier 95 to indicate a service was furnished via synchronous, real‑time audiovisual telehealth (a live audio‑video conference between patient and provider) rather than in‑person. - Pair…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207R00000X
    207P00000X
    364SX0200X
    125K00000X
    163WM0102X
    152WX0102X
    247ZC0005X
    281PC2000X

    Related Payer Policy Updates

    Specialty: Cardiology1 / 3

    10 rows

    PolicyPayerEffective Date
    Automated Ambulatory Blood Pressure Monitoring for Diagnosis of Hypertension in Patients with Elevated Office Blood PressureBluecross Idaho2026-11-01
    Cardiology - IvabradineCigna2026-10-15
    Cardiac Computed Tomography (CCT)/Coronary Computed Tomographic Angiography (CCTA)univerahealthcare2026-10-15
    Percutaneous Ventricular Assist DeviceUnitedHealthcare2026-10-01
    Cardiovascular Disease Risk AssessmentOscar Health2026-10-01
    Biomarkers for Myocardial Infarction and Chronic Heart FailureOscar Health2026-10-01
    Multiple Procedure Payment Reduction for Diagnostic Cardiovascular ProceduresBlue Cross Blue Shield - Maine2026-10-01
    Left Atrial Appendage Closure Devicesexcellus_health_plan_inc2026-09-17
    Left Atrial Appendage Closure Devicesuniverahealthcare2026-09-17
    Cardiac Omnibus CodesCigna2026-09-15

    Related Codes

    CPT-99291-CRITICAL-CARE-EVALUATION-MANAGEMENT-30-74-MINUTES

    CPT 99291: Initial Critical Care, 30–74 Minutes

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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    Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

    Relationship to This Procedure
    99291Critical care, evaluation and management of the critically ill or critically injured patient; first 30–74 minutesPrimary critical care code for the initial 30–74 minutes; 99292 is used as an add-on for each additional 30-minute increment beyond the first interval.