CPT code 99291: Critical care, initial service, at least 30 minutes2026 Medicare rate & RVUs in California
Report 99291 when a physician or qualified health care professional spends at least 30 minutes managing a patient at high risk of imminent, life-threatening deterioration.
Medicare pays $318.14–$381.70 for 99291 in the office in California, from Chico, CA to San Benito County, CA. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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What 99291 covers
Critical care involves active management of an illness or injury that acutely threatens a vital organ system, with a high likelihood of imminent, life-threatening deterioration. Typical situations include septic shock requiring vasopressors and acute respiratory failure requiring ventilatory support. Emergency physicians, intensivists, hospitalists, and other physicians or qualified health care professionals furnish it in an ICU, emergency department, or another setting. The patient's condition and the care provided, not the location, establish whether the service qualifies.
Report 99291 after at least 30 minutes of qualifying critical care on the same date. Intervals need not be continuous, but overlapping practitioners' time cannot be counted twice. Document the critical condition, interventions, and total qualifying time. Count bedside care and directly related work on the unit, including necessary discussions with surrogates when the patient cannot participate. Exclude time spent on separately billable procedures, such as intubation or central venous catheter insertion. Chest radiograph and blood gas interpretation, pulse oximetry, ventilator management, gastric intubation, and peripheral vascular access are included in critical care. For Medicare, the first unit of 99292 requires 104 total minutes.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
Where 99291 pays more and less in California
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
29 payment localities
$318.14 to $381.70
29 of 29 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Bakersfield, CA | $319.56 | $199.12 |
| Chico, CA | $318.14 | $197.70 |
| El Centro, CA | $318.22 | $197.78 |
| Fresno, CA | $318.14 | $197.70 |
| Hanford, CA | $318.14 | $197.70 |
| Los Angeles, CA | $336.18 | $206.18 |
| Madera, CA | $318.14 | $197.70 |
| Marin County, CA | $373.67 | $218.73 |
| Merced, CA | $318.14 | $197.70 |
| Modesto, CA | $318.14 | $197.70 |
| Napa, CA | $356.43 | $211.60 |
| Oxnard, CA | $333.45 | $203.56 |
| Redding, CA | $318.14 | $197.70 |
| Rest of California | $318.14 | $197.70 |
| Riverside, CA | $323.16 | $202.72 |
| Sacramento, CA | $330.60 | $202.80 |
| Salinas, CA | $329.27 | $201.91 |
| San Benito County, CA | $381.70 | $223.24 |
| San Diego, CA | $334.52 | $203.09 |
| San Francisco, CA | $373.15 | $218.21 |
| San Luis Obispo, CA | $324.30 | $199.14 |
| Santa Clara County, CA | $379.56 | $221.10 |
| Santa Cruz, CA | $335.79 | $202.28 |
| Santa Maria, CA | $329.82 | $201.69 |
| Santa Rosa, CA | $339.01 | $204.06 |
| Stockton, CA | $318.14 | $197.70 |
| Vallejo, CA | $355.68 | $210.85 |
| Visalia, CA | $318.14 | $197.70 |
| Yuba City, CA | $318.14 | $197.70 |
How the 99291 rate is calculated
Each of 99291’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 99291
RVUs × geographic indexes × conversion factor
Work4.50
4.50 RVUs× 1.000 GPCI
Practice expense4.29
4.29 RVUs× 1.000 GPCI
Malpractice0.46
0.46 RVUs× 1.000 GPCI
Adjusted RVUs
9.2500
Conversion factor
$33.4009
Medicare rate
$308.96
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 99291
99291 has no global surgery period, no multiple-procedure, bilateral or assistant-at-surgery adjustment, and no professional/technical split. What changes the payment is where the service happens: the place of service on the claim decides whether Medicare pays the office or the facility rate.
Place of service · 99291
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
POS 11 · non-facility rate · national
$308.96
- Non-facility (office)
- $308.96
- Facility
- $199.07
Higher because the practice carries its own overhead.
99291 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 99292Critical careEach additional 30 minutes
- 99291 reports the initial critical care service after at least 30 minutes. 99292 is an add-on for further time; Medicare requires 104 total minutes for its first unit.
- 99285ED visitHigh complexity decision making
- Choose 99285 for a high-complexity ED visit when the patient's condition or documented critical care time does not support 99291.
- 99233Hospital follow-up visitSubsequent day, high complexity
- 99233 covers a subsequent inpatient or observation visit selected by medical decision making or time. Choose 99291 when the patient's condition meets critical care criteria and at least 30 minutes of qualifying care is documented.
- 99471Pediatric critical careInitial day, age 29 days–24 months
- 99471 is a per-day code for initial inpatient critical care of children aged 29 days through 24 months. 99291 is time-based and can describe qualifying critical care in other settings.
99291 billing questions
When does Medicare allow 99292 to be added to 99291?
Medicare requires at least 104 total minutes of critical care for the first unit of 99292. CPT reporting starts the add-on at 75 minutes, so the threshold differs.
Can an ED visit and critical care be billed the same day?
Medicare allows both when a medically necessary, separately identifiable ED visit occurred before the patient's condition became critical. Append modifier 25 to the ED visit and document the change in condition.
Which procedures can be billed separately with 99291?
Endotracheal intubation, CPR, central venous catheter placement, arterial line placement, and cardioversion may be separately reported when performed. Exclude the time spent on each separately reported procedure from critical care time.
How is split or shared critical care reported?
When a physician and an NP or PA in the same group furnish critical care, add their nonoverlapping qualifying time. The practitioner who furnished more than half the total time reports the service with modifier FS.
Can two physicians bill critical care for the same patient on the same date?
Physicians of different specialties may each report medically necessary, nonduplicative critical care. Physicians of the same specialty in the same group are treated as one for reporting purposes, and their nonoverlapping time is combined.
Does an ICU admission automatically qualify for 99291?
No. Documentation must support an acute threat to a vital organ system, a high likelihood of imminent, life-threatening deterioration, the critical care provided, and at least 30 minutes of qualifying time.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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