CPT code 99292: Critical care, each additional 30 minutes2026 Medicare rate & RVUs in California
Report 99292 with 99291 when a physician or qualified health care professional provides enough additional critical care time for a critically ill patient.
Medicare pays $136.56–$161.23 for 99292 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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On this page 9 sections
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 in California
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
29 payment localities
$136.56 to $161.23
29 of 29 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Bakersfield, CA | $137.27 | $100.29 |
| Chico, CA | $136.56 | $99.58 |
| El Centro, CA | $136.59 | $99.62 |
| Fresno, CA | $136.56 | $99.58 |
| Hanford, CA | $136.56 | $99.58 |
| Los Angeles, CA | $143.79 | $103.88 |
| Madera, CA | $136.56 | $99.58 |
| Marin County, CA | $157.87 | $110.31 |
| Merced, CA | $136.56 | $99.58 |
| Modesto, CA | $136.56 | $99.58 |
| Napa, CA | $151.14 | $106.68 |
| Oxnard, CA | $142.45 | $102.57 |
| Redding, CA | $136.56 | $99.58 |
| Rest of California | $136.56 | $99.58 |
| Riverside, CA | $139.07 | $102.09 |
| Sacramento, CA | $141.41 | $102.17 |
| Salinas, CA | $140.83 | $101.73 |
| San Benito County, CA | $161.23 | $112.58 |
| San Diego, CA | $142.69 | $102.34 |
| San Francisco, CA | $157.61 | $110.05 |
| San Luis Obispo, CA | $138.75 | $100.33 |
| Santa Clara County, CA | $160.16 | $111.51 |
| Santa Cruz, CA | $142.94 | $101.95 |
| Santa Maria, CA | $140.96 | $101.63 |
| Santa Rosa, CA | $144.28 | $102.85 |
| Stockton, CA | $136.56 | $99.58 |
| Vallejo, CA | $150.77 | $106.30 |
| Visalia, CA | $136.56 | $99.58 |
| Yuba City, CA | $136.56 | $99.58 |
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.
How the rate is built · 99292
RVUs × geographic indexes × conversion factor
Work2.25
2.25 RVUs× 1.000 GPCI
Practice expense1.53
1.53 RVUs× 1.000 GPCI
Malpractice0.23
0.23 RVUs× 1.000 GPCI
Adjusted RVUs
4.0100
Conversion factor
$33.4009
Medicare rate
$133.94
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 99292
The CMS indicators that decide how 99292 is paid alongside other services.
CMS payment indicators · 99292
Critical care, each additional 30 minutes
| Rule | CMS value | What it means |
|---|---|---|
| Global period | ZZZ | Add-on code: falls within the primary procedure’s global period. |
| Multiple procedures | 0 | No multiple-procedure reduction. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
99292 compared with similar codes
Compare codes · National
4 codes, side by side
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.
99292 billing questions
When is 99292 reported with 99291?
Report 99292 for qualifying critical care time beyond the time represented by 99291. One unit generally applies at 75–104 total minutes; additional units require additional qualifying time.
Can 99292 be billed by itself?
No. It is an add-on code and must be reported with 99291 as the primary critical care service.
Does the patient have to be in an ICU?
No. Critical care may be furnished in an emergency department or another setting; the patient’s life-threatening condition and the services provided support the code.
What time should the record support?
Document total critical care time for the date, the patient’s critical condition, and the management performed. Do not include time spent on separately reportable procedures.
How is 99292 different from a high-level emergency visit?
99292 is additional time for critical care reported with 99291. A high-level emergency department evaluation code describes an ED visit that does not meet critical care criteria.
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
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