CPT 99291: critical care, first 30 to 74 minutes
99291 reports the first 30 to 74 minutes of critical care for one patient on one date, and Medicare pays it once per date. It is chosen by time alone, with no decision making level, and the next code, 99292, only begins when the date reaches 104 minutes.
Written by Salman Saeed, CEO and Co-Founder · Reviewed by a Certified Medical Coder · Last reviewed October 2026In short: 99291 is billed when a practitioner gives 30 to 74 minutes of critical care on a date, and only once per date, even if the time is split up. At 104 minutes the claim adds 99292 for each full 30 more. The chart must show the total time and exclude minutes spent on separately billed procedures.
What does CPT 99291 report?
99291 reports the first block of critical care time one practitioner gives one patient on one date. Medicare adopts the CPT definition: acute impairment of one or more vital organ systems, a probability of imminent or life-threatening deterioration, and high complexity decision making (Chapter 12, section 30.6.12.1). The patient's condition decides it, not the room.
| Item | Value in the file |
|---|---|
| Payment status | A (active code) |
| Work RVU | 4.50 |
| Total RVU, non-facility / facility | 9.25 / 5.96 |
| Global period | XXX |
How many minutes do you need to bill 99291?
You need at least 30 minutes of critical care on the date. Section 30.6.12.2 says a single physician or NPP who furnishes 30 to 74 minutes reports 99291, once per date, even if the time is not continuous.
| Critical care time on the date | What Medicare expects |
|---|---|
| Under 30 minutes | Do not bill 99291; the threshold is not met |
| 30 to 74 minutes | 99291, one unit |
| 104 minutes or more | 99291 plus 99292 for each full added 30 minutes |
Separate stretches can be added up if each one is medically necessary and is itself critical care. A service that runs through midnight without a break is reported on the date it began; any break creates a new initial service, so a new 99291.
A physician records 38 minutes of critical care at 06:10 and 45 minutes at 14:30. Total time is 83 minutes. The claim carries 99291 with 1 unit and no 99292.
Which services are inside 99291?
Section 30.6.12.1 lists what CPT bundles into critical care and Medicare does not pay separately: cardiac output interpretation, chest X-rays, pulse oximetry, blood gases, ECG and blood pressure data, gastric intubation, temporary transcutaneous pacing, ventilator management and vascular access.
Time on a separately reportable procedure comes out of the critical care minutes. The 2026 NCCI Policy Manual, Chapter XI, uses CPR (92950) as its example. For infants, 99468 to 99480 are per diem codes with their own rules; see CPT 99468 and neonatology billing.
Who bills 99291 when more than one practitioner is involved?
Each specialty bills its own 99291 (section 30.6.12.3). Inside one group and specialty, only one 99291 is paid per patient and date; colleagues report their time as 99292, and a colleague can continue if the first practitioner fell short of 30 minutes (section 30.6.12.4).
A physician and a nurse practitioner are different specialties for this purpose, so section 30.6.12.5 treats their care as a split or shared visit. The practitioner with more than half of the total time bills, and modifier FS goes on every critical care line.
Can you bill an ED visit or a procedure the same day?
Yes, in narrow cases. Section 30.6.12.6 requires the other E/M visit to come before the critical care, when the patient did not need it, to be medically necessary and to have no duplicated work, with modifier 25 on the claim. The MLN booklet words the placement differently, so confirm with your MAC. See CPT 99285.
Critical care unrelated to a surgery in its global period is paid separately with modifier FT (section 30.6.12.7).
How does 99291 appear on the claim?
On the CMS-1500, Item 24D carries 99291, Item 24G carries 1 unit, and Item 24B carries POS 23 (hospital emergency room) or 21 (inpatient hospital). The practitioner MUE table effective October 1, 2026 lists 99291 at 1 per date, adjudication indicator 2 (date of service edit, policy).
Document the total time each practitioner spent, not necessarily start and stop times, with medical necessity (section 30.6.12.8).
How do hospitals bill critical care on the UB-04?
Chapter 4 section 160.1 tells hospitals to follow CPT for 99291, with the code in FL 44 of the outpatient UB-04 and ancillary services reported separately. Modifier 59 can show that an ancillary service was a different encounter the same day.
Time counts only as active face-to-face care by a physician and hospital staff, and simultaneous time counts once. Under 30 minutes, the hospital bills a visit at its own level. If trauma activation meets the NUBC criteria, the hospital adds a 68x revenue line on the same date and one unit of G0390.
A designated trauma center receives a patient after prehospital notification and the physician documents 52 minutes. The hospital claim has 99291 in FL 44, a 68x line and G0390 with 1 unit. The physician's CMS-1500 has 99291 in Item 24D and 1 in Item 24G.
Why does a 99291 claim deny?
| Code | What X12 says | What usually causes it |
|---|---|---|
| CO-97 | Included in the payment for another service already adjudicated | An ED or hospital visit paid first; timing and modifier 25 not clear |
| CO-4 | The procedure code is inconsistent with the modifier used | FS, 25 or FT missing |
| CO-150 | The information submitted does not support this level of service | No total time in the note |
| CO-50 | Not deemed a medical necessity by the payer | No organ system failure shown |
If these denials keep coming back, our denial management team can work them. Our medical coding team can also check time statements before submission.
Related codes
- Medicare Claims Processing Manual, Chapter 12: Physicians/Nonphysician Practitioners · CMS
- Evaluation and Management Services (MLN006764, May 2026) · CMS
- FAQs: Split (or Shared) Visits and Critical Care Services (April 7, 2022) · CMS
- 2026 NCCI Medicare Policy Manual, Chapter XI: Medicine and Evaluation and Management Services · CMS
- Physician Fee Schedule relative value files, RVU26D (October 2026) · CMS
- Medicare NCCI Medically Unlikely Edits, practitioner services table, effective 10-01-2026 · CMS
- Medicare Claims Processing Manual, Chapter 26: Completing and Processing Form CMS-1500 Data Set · CMS
- Place of service code set · CMS
- Claim Adjustment Reason Codes · X12
- Medicare Claims Processing Manual, Chapter 4: Part B Hospital (Including Inpatient Hospital Part B and OPPS) · CMS
- Medicare Claims Processing Manual, Chapter 25: Completing and Processing the Form CMS-1450 Data Set · CMS
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Common questions
Straight answers from the team that does the work.
Ask a billing lead directly. A 20-minute call, Monday to Friday, 9am to 5pm Eastern.
01How many minutes are needed to bill 99291?
Thirty minutes of critical care on the date. Medicare pays 99291 for 30 to 74 minutes, once per date, even if the time is not continuous. Under 30 minutes does not meet the threshold, and 99292 begins at 104 minutes under Chapter 12, section 30.6.12.2.
02Who bills critical care when two practitioners in the same group share the time?
Same specialty: the first reports 99291, the others report 99292, and times are added. Physician plus NPP: it is a split or shared visit, so the one with more than half the time bills, with FS on each critical care line.
03Which procedures are included in critical care and which are separate?
Section 30.6.12.1 bundles chest X-ray interpretation, pulse oximetry, blood gases, ECG and blood pressure data, gastric intubation, temporary pacing, ventilator management and vascular access. Other procedures, such as CPR, are billed separately and their minutes are left out of critical care time.
04Can I bill an ED visit and 99291 on the same date?
Sometimes. The ED visit must come before the critical care, when the patient did not need it, and be separate and medically necessary. Section 30.6.12.6 then calls for modifier 25 on the claim. Check with your MAC where it wants the modifier placed.
05Do I need start and stop times for critical care?
No. Section 30.6.12.8 requires the total time each reporting practitioner spent, not necessarily start and stop times. The note should still show medical necessity and, when others were involved, each person's role in the care. Prolonged service codes are not reported with critical care.
Critical care time getting questioned?
We check the time statements and same-day visit support before critical care claims go out.