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.
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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.