CPT 99292E&M

Critical care addl 30 min

CPT 99292 is billed for each additional 30 minutes of critical care provided to a critically ill or injured patient beyond the first hour. This add-on code is used only after billing the initial critical care code (99291).

Showing rates for

National Average

Base Medicare rate

$115.48

This calculator gives a typical-case estimate using standard Medicare modifier rules. Actual payment depends on payer policies, documentation, code-specific CMS status indicators, and locality. Verify before billing.

RVU breakdown

Work RVU

2.25

PE RVU (NF)

1.11

MP RVU

0.21

Total RVU

3.57

Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High

NCCI bundling edits

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Billing tips

Report 99292 only in conjunction with 99291 and only after accumulating at least 30 minutes beyond the initial 74 minutes (total 104 minutes minimum)
Impact: Prevents automatic denials; ensures compliance with CPT guidelines that require 99291 first and minimum time thresholds
Document cumulative critical care time precisely, excluding time spent on separately billable procedures (central line placement, intubation, etc.)
Impact: Audit protection worth $102.86-$115.48 per unit; improper time documentation is the #1 reason for critical care downcoding
Bill multiple units of 99292 when providing extended critical care: 105-134 minutes = 1 unit of 99292, 135-164 minutes = 2 units, 165-194 minutes = 3 units
Impact: Each additional properly documented unit generates $115.48 (non-facility); missing even one 30-minute increment loses substantial revenue
Do not report 99292 for neonates (28 days or younger) - use 99469 instead for additional critical care time
Impact: Using wrong code family results in 100% denial; pediatric/neonatal critical care codes have different time thresholds and bundled services
Critical care on same date as procedures: separately report insertion of central lines (36555-36556), endotracheal intubation (31500), chest tube (32551), but do NOT count this procedural time toward 99291/99292
Impact: Proper unbundling can add $200-$500 per encounter while maintaining compliance; mixing times triggers audits
For split/shared critical care visits in teaching hospitals, follow split/shared guidelines effective 2023; attending must be present for critical portion of service

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Frequently asked questions

How much does Medicare pay for CPT code 99292 in 2025?

Medicare pays $115.48 for CPT 99292 in non-facility settings and $102.86 in facility settings based on the 2025 national average rates. The code has 3.57 total RVUs (2.25 work RVU, 1.11 non-facility PE RVU, 0.72 facility PE RVU, and 0.21 MP RVU) multiplied by the 2025 conversion factor of 32.3465.

Can you bill 99292 without 99291?

No, CPT 99292 is an add-on code that can only be billed in conjunction with 99291 on the same date of service. You must first bill 99291 for the initial 30-74 minutes of critical care before reporting 99292 for each additional 30-minute increment.

How many minutes are required to bill 99292?

You need a cumulative total of at least 104 minutes of critical care time to bill one unit of 99292 (74 minutes for 99291 plus 30 additional minutes). Each subsequent unit of 99292 requires an additional 30 minutes: 135-164 minutes = 2 units of 99292, 165-194 minutes = 3 units, and so on.

How many times can you bill 99292 per day?

There is no specific limit on units of 99292 per day as long as the time is medically necessary, accurately documented, and represents actual critical care provided. However, billing more than 4-5 units (indicating 3+ hours of critical care) may trigger payer scrutiny and require exceptional documentation of medical necessity.

What is the difference between 99291 and 99292?

99291 covers the first 30-74 minutes of critical care on a given date and can only be billed once per day. 99292 is an add-on code for each additional 30-minute increment beyond 74 minutes and can be billed multiple times per day. 99291 must always be billed before any units of 99292.

Can nurse practitioners bill CPT 99292?

Yes, nurse practitioners and physician assistants can bill 99292 within their scope of practice and state regulations. In facility settings, NPPs are typically reimbursed at 85% of the physician fee schedule rate. Documentation requirements are identical regardless of provider type, and the same time thresholds apply.

What procedures cannot be included in 99292 time?

Time spent performing separately billable procedures must be excluded from critical care time. This includes central line insertion (36555-36556), endotracheal intubation (31500), chest tube placement (32551), lumbar puncture (62270), cardioversion (92960), and ventilator management codes when billed separately. Only time spent on evaluation, management, and non-procedural interventions counts toward 99291/99292.