CPT 99291 & CPT 99292 (Critical Care Services)
CPT 99291 Description: CPT 99291 may be used for for a critical care service provided for a minimum of 30 and a maximum of 74 minutes. CC services that are provided for less than 30 minutes must be billed with the correct level of Evaluation and Management code.
Critical care services include:
- prevention of further life–threatening conditions
- the treatment of vital organ failure.
The following three criteria must be met for reporting CC service:
- An absolute requirement is the proper documentation showing the medical necessity for providing CC services.
- The time spent in providing the care.
- The severity of illness the intensity of services required to treat the illness.
Most of the times a critical care service is provided to a patient in a “critical care area” such as:
- An emergency room
- intensive care unit (ICU)
- Respiratory care unit
- Coronary care unit (CCU)
Note: Delivering medical care in time of emergency and/or a moment of crisis and is not the only requirement for providing CC services. The use of ventilation nor presence of a patient in an ICU the is not sufficient to bill a CC service.
CPT 99292 Description: CPT 99292 is an add-on code. This is an “add–on” code from CPT 99291 and can only be used with the primary CPT code 99291. CPT 99292 can be used for a critical care service provided for every extra 30 minutes of service after the first 30–74 minutes (see CPT 99291) of direct critical care treatment provided.
