Frequently Asked Questions(FAQ) About CPT 99291 and 99292

1. What is CPT code 99291 used for?

CPT 99291 is used to report the first 30–74 minutes of critical care services delivered to a critically ill or injured patient on a given calendar date. It can only be billed once per patient per day by the same provider or group of the same specialty.

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2. What is the difference between CPT 99291 and 99292?

• CPT 99291 covers the initial 30–74 minutes of critical care.

• CPT 99292 covers each additional 30-minute increment beyond the first 74 minutes.
  Medicare requires a full 30 minutes to report 99292, while some commercial payers may allow partial increments.

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3. Can you bill CPT 99291 and 99292 on the same day?

Yes. If critical care extends beyond 74 minutes, you may bill 99291 + 99292 (and multiple 99292 codes if additional 30-minute intervals are met). All time must be properly documented.

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4. Can multiple providers bill 99291 for the same patient?

No, not if they are from the same group and specialty—only one 99291 can be billed per day. However, if providers from different specialties treat distinct critical conditions, each may bill 99291.

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5. Can you bill an E/M visit with critical care codes?

Yes, but only if the E/M service is separately identifiable, medically necessary, and non-duplicative from the critical care service. Append modifier 25 to the E/M code when billing alongside 99291 or 99292.

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6. What procedures are bundled into critical care time?

Certain services are bundled and cannot be billed separately, such as ventilator management, pulse oximetry, and NG tube placement.
However, procedures like central line placement, chest tube insertion, and CPR are billable separately—and their time must be excluded from critical care minutes.

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7. How should you document critical care time?

Documentation must include:

• Total time spent on critical care

• A description of the patient’s critical condition

• Services performed and interventions provided

• Any excluded procedures (with separate documentation)

Clear documentation is essential to avoid denials and ensure compliance with Medicare and payer policies.