CPT 99292: critical care, each added 30 minutes
99292 is the add-on for each whole 30 minutes of critical care beyond the first block billed as 99291. Medicare counts that first block through 74 minutes, so the first unit needs 104 total minutes on the date.
Written by Salman Saeed, CEO and Co-Founder · Reviewed by a Certified Medical Coder · Last reviewed October 2026In short: 99292 is billed only with 99291 and only for full added 30 minute increments, starting at 104 total minutes. Separate stretches on the same date are added together, and CMS gives no rounding. The practitioner MUE is 8 units per date.
What does CPT 99292 report?
99292 reports each additional full 30 minutes of critical care after the first block that 99291 covers. It is an add-on code: it never appears alone, and it needs a 99291 for the same patient and date.
| Item | Value in the file |
|---|---|
| Payment status | A (active code) |
| Work RVU | 2.25 |
| Total RVU, non-facility / facility | 4.01 / 3.00 |
| Global period | ZZZ (add-on) |
| NCCI MUE, practitioner table Q4 2026 | 8 per date, indicator 3 |
When can 99292 be billed in addition to 99291?
Medicare counts the first block as ending at 74 minutes, so the first unit of 99292 needs 104 total minutes on the date. Chapter 12, section 30.6.12.2, says 99292 is for additional 30-minute increments, and CMS's April 2022 FAQ adds that a whole extra 30 minutes must be completed.
| Total critical care minutes | Codes | 99292 units |
|---|---|---|
| Under 104 | 99291 only | 0 |
| 104 to 133 | 99291 and 99292 | 1 |
| 134 to 163 | 99291 and 99292 | 2 |
| 164 to 193 | 99291 and 99292 | 3 |
There is no rounding. The CMS FAQ answers directly that a practitioner with more than 74 minutes may report 99292 only after a whole additional 30-minute increment, in other words at 104 minutes. 103 minutes is 99291 alone.
Can time be added across the day for 99292?
Yes, if each stretch is medically necessary critical care. Section 30.6.12.2 lets non-continuous time be aggregated for the date, and the unit count comes from the daily total.
A service that crosses midnight without a break is reported with its total time on the date it began. A break starts a new initial service, which means the next date opens with its own 99291 and the minutes do not carry over.
A physician gives 40 minutes at 02:00, 30 minutes at 09:00 and 45 minutes at 16:00, all critical care. The total is 115 minutes. The claim carries 99291 once and 99292 once. The other 11 minutes beyond 104 do not make a second unit.
Does Medicare use the same 99292 threshold as CPT?
For services since January 1, 2022, Medicare says it adopts CPT's reporting rules for critical care by a single practitioner (section 30.6.12.2), so the 104 minute point matches. This page cannot state the AMA's own text, which is copyrighted and was not opened.
Commercial payers write their own policies. Check the payer manual before assuming the Medicare thresholds apply.
Who reports 99292 when several people share the care?
In one group and specialty, a practitioner who does the full initial service reports 99291, and others in that group report their added time as 99292 (section 30.6.12.4). Once 99291 is met, a further 99292 needs another full 30 minutes.
In a physician and NPP split or shared service (section 30.6.12.5), the billing practitioner reports 99291 and then one or more 99292 once the cumulative time reaches 104 minutes. Modifier FS goes on each critical care code. Prolonged service codes are not reported with critical care (section 30.6.15.3).
How does 99292 appear on the claim?
On the CMS-1500, 99292 sits on a second Item 24 line under 99291, with Item 24G showing the added 30 minute units and the same Item 24B place of service. FS or FT, when they apply, go on the 99292 line too.
The practitioner MUE table lists 99292 at 8 per date with indicator 3, which the file labels a clinical date of service edit. Eight units would take 314 minutes in total, so claims near that value draw review. See critical care billing and emergency medicine billing.
How do the extra units appear on the hospital claim?
The professional claim counts units; the facility claim handles 99292 differently. Chapter 4 section 160.1 says 99292 is packaged under the OPPS, so hospitals do not have to track the time of each critical service, but it should be reported if provided. The hospital line has the revenue code in FL 42 and the code in FL 44.
The same time rule applies. The time a hospital may count is active face-to-face care by a physician or hospital staff, and simultaneous time counts once. A physician claim and a hospital claim for the same patient therefore do not need the same number of units.
A physician documents 150 minutes of critical care across the date. The professional claim carries 99291 with 1 unit and 99292 with 2 units (134 to 163 minutes). The hospital reports 99292 as a packaged service even though it is not paid separately.
Why does a 99292 line deny?
| Code | What X12 says | What usually causes it |
|---|---|---|
| CO-151 | The information submitted does not support this many or this frequency of services | Units above what the note's total time supports |
| B15 | A qualifying service must be received and covered | The 99291 line was denied or missing |
| CO-4 | The procedure code is inconsistent with the modifier used | FS missing on a split or shared line |
| CO-150 | The information does not support this level of service | Total time not stated |
If these denials keep coming back, our denial management team can work them. Compare CPT 99285 for the ED visit that often sits beside it.
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
- Claim Adjustment Reason Codes · X12
- Medicare Claims Processing Manual, Chapter 4: Part B Hospital (Including Inpatient Hospital Part B and OPPS) · CMS
We check every rule, code and deadline against the official source. See our editorial policy.
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.
01When can 99292 be billed in addition to 99291?
Only when total critical care time for the patient and date reaches 104 minutes. Medicare treats the first 74 minutes as 99291. Each further whole 30 minutes is one unit of 99292, so 134 minutes is two units and 103 minutes is none.
02Does Medicare use the same 99292 threshold as CPT?
Medicare says in section 30.6.12.2 that it adopts CPT's reporting rules for critical care by a single practitioner, and the 104 minute point comes from that. Commercial payers set their own rules, so read the payer manual before applying the Medicare numbers.
03Can time be added across the day for critical care?
Yes. Non-continuous time may be aggregated if it is medically necessary and each stretch is critical care. A service that runs through midnight is reported on the starting date, but a break creates a new initial service and a new 99291.
04Is there a limit on 99292 units?
The practitioner MUE table effective October 1, 2026 sets 8 units per date with indicator 3. That value would need 314 minutes of critical care, so a claim at the limit should have a note that clearly supports the time.
05Can a nurse practitioner's time count toward 99292?
If the NPP and physician are in the same group, it is a split or shared critical care visit. Their times are added, the one with more than half bills 99291 and any 99292 with modifier FS, and overlapping joint time counts only once.
Critical care units getting cut?
We reconcile the total time in each note with the units billed.