CPT code 99291: Critical care, initial service, at least 30 minutes2026 Medicare rate & RVUs in Washington, DC area

In Washington, DC area, Medicare pays $344.32 for 99291 in the office and $214.87 when it’s performed in a hospital or facility.

Check a contract rate as a % of Medicare · 99291 nationwide

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

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.

How Washington, DC area compares for 99291

Across 109 of 109 payment localities, the office rate for 99291 runs from $281.30 in Arkansas to $386.53 in Alaska. Washington, DC area pays $344.32. The RVUs are the same everywhere; the geographic indexes change the dollars.

Every other payment area

99291 rates by state

Office rate range in each state. Select a state to see its payment localities.

See 99291 in every payment locality

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.

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.

Codes related to 99291

Related codes aren’t interchangeable: bill the code that matches the service performed.

How 99291 has changed in Washington, DC area

Price 99291 for an earlier date of service

Where the Washington, DC area rate applies

Washington, DC area is a Medicare payment area, not a city. Our Census mapping connects it to 1 cities and communities in District of Columbia. Some span more than one payment area; confirm with the service ZIP.

• Washington

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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

Open CMS sourceHow we calculate rates