(2023) CPT 99291 & CPT 99292 (Critical Care Services)
CPT 99291 Description: CPT 99291 may be used for a critical care service for a minimum of 30 and a maximum of 74 minutes. CC services for less than 30 minutes must be billed with the correct Evaluation and Management code level.
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.
Critical Care Services
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 the illness and the intensity of services required to treat the illness.
Most of the time 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 emergencies and a crisis is not the only requirement for providing CC services. The use of ventilation nor the presence of a patient in an ICU is insufficient to bill a CC service.
