When it comes to critical care coding, two of the most important CPT codes are 99291 and 99292. These codes are essential for accurately reporting physician services provided to critically ill or injured patients. Because correct coding impacts compliance and reimbursement, it’s vital to understand how and when to use these codes.
In this article, we’ll break down the official guidelines for CPT 99291 and CPT 99292, including time requirements, billing rules, Medicare considerations, and common pitfalls.
What is CPT 99291?
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CPT 99291 is used to report the first 30–74 minutes of critical care services provided on a given calendar date.
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This code can only be billed once per patient per date of service, per physician (or group of the same specialty).
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If critical care is provided for less than 30 minutes, 99291 cannot be used. Instead, use the appropriate E/M (evaluation and management) codes, such as 99232 or 99233.
What is CPT 99292?
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CPT 99292 is reported for each additional 30-minute increment of critical care beyond the initial 74 minutes billed under 99291.
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According to Medicare (CMS) guidelines, you must complete a full 30 minutes beyond the initial 74 minutes (≥104 minutes total) before billing 99292.
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Some commercial payers may accept partial 30-minute increments, but always confirm payer policy.
Time-Based Coding: CPT 99291 vs 99292
Here’s a quick chart to help determine which code(s) to bill:
👉 Pro Tip: Always document total time and specify what portion was spent in critical care vs. procedures.
Aggregation and Multiple Providers
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Same specialty, same group: Only one 99291 may be billed per patient per day. Additional time is billed with 99292.
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Different specialties: If separate critical conditions are treated, each physician may bill 99291, provided services are distinct and not duplicative.
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Aggregated time: Critical care time can be added up throughout the day, even if not continuous.
Split/Shared Critical Care Services
Since 2022, CMS has specific rules for split/shared critical care:
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Critical care cannot be split between a physician and NPP. Instead, the provider who delivers more than 50% of total time should bill the service.
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Use modifier -FS to indicate split/shared services.
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If total time exceeds 74 minutes, 99292 may also be billed with the same modifier.
Critical Care + Other E/M Services
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If a non-critical E/M visit (e.g., hospital or office visit) is performed earlier in the day, it may be billed in addition to critical care—but only if it is distinct, medically necessary, and non-duplicative.
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Always append modifier 25 to the E/M service in this scenario.
Bundled vs. Separately Billable Procedures
Some procedures are bundled into critical care and cannot be billed separately, including:
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Ventilator management
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NG Tube placement
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Lab monitoring
Other procedures may be billed separately (time for these cannot be included in critical care minutes):
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Central line placement
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Chest tube insertion
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CPR
Key Takeaways
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99291 = first 30–74 minutes of critical care (bill once per day).
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99292 = each additional 30-minute block (Medicare requires a full 30 minutes).
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Time may be aggregated across the day, but not split across specialties in the same group.
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Always check Medicare vs. commercial payer rules for increments.
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Document clearly and thoroughly—time, activities, and procedures are critical for compliance.
Final Thoughts
Accurate billing for CPT 99291 and CPT 99292 ensures compliance, prevents denials, and maximizes reimbursement. With Medicare and commercial payers applying slightly different rules, staying up to date is essential. Proper documentation of time and critical care services is the most important factor in avoiding coding mistakes.
By following these CPT guidelines for critical care, providers can deliver quality care while ensuring proper compensation for the intensity and complexity of services provided.
