Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes
💬 Plain Language Explanation
What this means
This is critical care - intensive care provided to a critically ill or injured patient. Your doctor spent significant time (at least 30 minutes) providing life-saving or intensive care.
Why you might see this
This code is used when you received critical care in an intensive care unit (ICU) or emergency situation. It's for patients who are critically ill or injured and require intensive monitoring and treatment.
Common context
Used for critically ill or injured patients requiring intensive care, often in ICU settings or emergency situations.
What to ask your provider
"'Why was critical care necessary? How much time was spent providing critical care?'"
Relative Value Units (RVUs)
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Clinical Information
When to Use
For evaluation and management of critically ill or injured patients in intensive care settings
Common Scenarios
Documentation Requirements
- High complexity medical decision making
- Continuous monitoring documentation
- Interventions and medications administered
- Time spent and critical care procedures
- Assessment of critical illness severity
Coding Guidelines
Common Modifiers
Bundling Rules
- Includes all critical care evaluation and management
- Includes interpretation of monitoring and labs
- Includes direct bedside care and time
Exclusions
- Do not bill with other E&M on same day without modifier 25
- Do not use for non-critically ill patients
Coding Notes
Clinical scenarios
- High complexity medical decision making
- Continuous monitoring documentation
- Interventions and medications administered
- High complexity medical decision making
- Continuous monitoring documentation
- Interventions and medications administered
- High complexity medical decision making
- Continuous monitoring documentation
- Interventions and medications administered
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Code Details
Medicare Pricing
PFSRVU Breakdown
OPPS Details
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Frequently Asked Questions
CPT 99291 is the billing code for "Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes". For evaluation and management of critically ill or injured patients in intensive care settings
Medicare pays approximately $265.56 for CPT 99291 (national average). Actual payment varies by geographic location due to GPCI adjustments. Hospital and commercial insurance rates are typically 2-4x higher than Medicare rates.
CPT 99291 has a total RVU of 10.20, broken down as: Work RVU 4.50, Practice Expense RVU 5.20, and Malpractice RVU 0.50. RVUs (Relative Value Units) determine Medicare reimbursement rates.
Key documentation requirements for CPT 99291 include: High complexity medical decision making; Continuous monitoring documentation; Interventions and medications administered; Time spent and critical care procedures. Missing or incomplete documentation is a leading cause of claim denials for this code.
Bundling considerations for CPT 99291: Includes all critical care evaluation and management. Includes interpretation of monitoring and labs Use an NCCI bundling checker to verify specific code combinations before billing.
Common modifiers for CPT 99291 include: 25 (Separate E&M from procedure on same day), 59 (Distinct procedural service), 91 (Repeat clinical observation). Modifiers indicate special circumstances and can affect reimbursement or prevent claim denials.
The typical time requirement for CPT 99291 is First 30-74 minutes of critical care time. Time-based codes require documentation of the actual time spent providing the service.