CPT code 99292: Critical care, each additional 30 minutes2026 Medicare rate & RVUs

Medicare pays $133.94 for 99292 nationally in the office and $100.20 in a hospital or facility. Local office rates run $123.01–$171.39.

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

What 99292 covers

Code 99292 represents additional time spent managing a critically ill or injured patient whose condition creates a high risk of imminent, life-threatening deterioration. A physician or qualified health care professional may provide this care in settings such as an intensive care unit or emergency department; the patient’s acuity and the services furnished, not the unit’s name, support critical care. The work involves focused assessment and management of life-threatening organ-system problems, rather than routine monitoring or a high-complexity visit alone.

Report 99292 only with 99291, when documented critical care time meets the threshold for an additional unit: generally 75–104 minutes total for one unit, with another unit for each additional qualifying interval. Document the patient’s critical condition, the critical care services, and the total time for the date, excluding time spent on separately reportable procedures. CMS treats 99292 as an add-on code billed with a primary service and paid within that service’s global period.

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 99292 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

99292 rates by state

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

How the 99292 rate is calculated

Each of 99292’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 99292

The CMS indicators that decide how 99292 is paid alongside other services.

99292 compared with similar codes

How to choose

99291Critical careInitial service, at least 30 minutes

99291 reports the primary critical care service; 99292 reports qualifying additional critical care time and must be paired with 99291.

99285ED visitHigh complexity decision making

99285 is an emergency department evaluation code. Use 99292 only as additional time with 99291 when the patient’s condition and services meet critical care criteria.

99223Initial hospital visitHigh decision making or 75 minutes

99223 describes an initial hospital or observation evaluation. 99292 is reserved for additional time in a critical care service, not a high-level admission evaluation.

Codes related to 99292

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

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