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

Report 99292 with 99291 when a physician or qualified health care professional provides enough additional critical care time for a critically ill patient.

CMS RVU26DEffective Oct 1, 2026One payment locality406K Medicare services in 2024

In Virginia, Medicare pays $130.81 for 99292 in the office and $97.65 when it’s performed in a hospital or facility.

$130.81Office (non-facility)
$97.65Hospital or facility
−2.3%vs the national office rate ($133.94)

Check a contract rate as a % of Medicare · 99292 nationwide

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

We’ll open 99292 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Virginia
  2. What 99292 covers
  3. Compared with other areas
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Related codes
  8. Rate history
  9. Where it applies
  10. Billing questions
  11. Sources

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.

How Virginia compares for 99292

Across 109 of 109 payment localities, the office rate for 99292 runs from $123.01 in Arkansas to $171.39 in Alaska. Virginia pays $130.81. The RVUs are the same everywhere; the geographic indexes change the dollars.

99292 in Virginia vs other payment areas
  1. Virginia · this page$130.81
  2. Los Angeles, CA · California$143.79+$12.98
  3. Washington, DC area · District of Columbia$147.96+$17.15
  4. Miami, FL · Florida$147.78+$16.97
  5. Chicago, IL · Illinois$144.67+$13.86
  6. Manhattan, NY · New York$151.53+$20.72
  7. Alaska · Alaska$171.39+$40.58

Other areas in Virginia first, then benchmark localities. Bars start at $0.

Every other payment area

99292 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$124.22$94.70
ArkansasArkansas$123.01$94.03
ArizonaArizona$131.25$98.56
Bakersfield, CACalifornia$137.27$100.29
Chico, CACalifornia$136.56$99.58
El Centro, CACalifornia$136.59$99.62
Fresno, CACalifornia$136.56$99.58
Hanford, CACalifornia$136.56$99.58

99292 rates by state

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

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

Explore a state

Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

$123.01

$171.39

Color shows the midpoint of each state’s locality range.

View every state and territory as a table
99292 office rate range by state
State / territoryOffice rate rangeLocalities
AK$171.391
AL$124.221
AR$123.011
AZ$131.251
CA$136.56–$161.2329
CO$136.431
CT$140.991
DC$147.961
DE$132.921
FL$135.55–$147.783
GA$129.89–$136.522
GU$137.701
HI$137.701
IA$124.961
ID$125.801
IL$133.82–$144.674
IN$126.261
KS$125.221
KY$127.611
LA$127.74–$131.972
MA$136.29–$146.092
MD$134.67–$147.963
ME$126.95–$130.642
MI$130.48–$137.422
MN$130.011
MO$126.69–$131.503
MS$124.831
MT$133.921
NC$127.741
ND$129.371
NE$125.221
NH$135.071
NJ$142.39–$147.372
NM$131.241
NV$132.711
NY$129.10–$154.995
OH$129.551
OK$126.761
OR$131.45–$138.852
PA$129.32–$138.872
PR$134.381
RI$136.221
SC$128.901
SD$128.841
TN$125.731
TX$128.79–$137.078
UT$130.091
VA$130.81–$147.962
VI$134.381
VT$129.631
WA$135.79–$147.892
WI$126.481
WV$130.551
WY$131.941

See 99292 in every payment locality

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

Office or facility?

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.

The exact Virginia inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

13,044

Code
99292
Physician work
2.25
Practice expense
1.53
Malpractice
0.23

GPCI2026.csv

106

Locality
Virginia
Physician work
1.000
Practice expense
0.983
Malpractice
0.706
Office calculation for 99292 in Virginia
ComponentRVULocality factorAdjusted
Physician work2.25× 1.0002.2500
Practice expense1.53× 0.9831.5040
Malpractice0.23× 0.7060.1624
Total RVUs3.9164
Conversion factor× 33.4009

Office rate, Virginia$130.81

Office: (2.25 × 1 + 1.53 × 0.983 + 0.23 × 0.706) × $33.4009 = $130.81

Facility: (2.25 × 1 + 0.52 × 0.983 + 0.23 × 0.706) × $33.4009 = $97.65

Open 99292 in the RVU calculator

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

RuleCMS valueWhat it means
Global periodZZZAdd-on code: falls within the primary procedure’s global period.
Multiple procedures0No multiple-procedure reduction.
Bilateral (modifier 50)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)0Not paid without supporting documentation.
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.

Codes related to 99292

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

Codes related to 99292
CodeHow it relatesOffice range, Virginia
Add-on codes
99291Critical care, initial service, at least 30 minutesPrimary critical care service required when reporting 99292.$302.01
Used instead
99285ED visit, high complexity decision makingHigh-level emergency department evaluation when critical care criteria are not met.No office rate
99223Initial hospital visit, high decision making or 75 minutesInitial hospital or observation evaluation when critical care is not supported.No office rate

How 99292 has changed in Virginia

99292 · Office / nonfacility

$130.81

Effective 2026-10-01

The base rate is $17.43 higher than on 2025-10-01, moving from $113.38 to $130.81 (15.4%).

It is unchanged from the immediately preceding available release, effective 2026-07-01.

Base rate by release · bars start at $0 · select a bar to compare

One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.

What changed, release by release

  1. January 1, 2026

    RVU26A

    $113.38changed to$130.81

    • Conversion factor 32.3465 changed to 33.4009
    • Practice expense RVU 1.11 changed to 1.53
    • Malpractice RVU 0.21 changed to 0.23
    • Work GPCI 1.002 changed to 1.000
    • Practice expense GPCI 0.984 changed to 0.983
    • Malpractice GPCI 0.755 changed to 0.706

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $116.86changed to$113.38

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 1.10 changed to 1.11
    • Malpractice RVU 0.23 changed to 0.21

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $114.95changed to$116.86

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $118.64changed to$114.95

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 1.08 changed to 1.10
    • Malpractice RVU 0.22 changed to 0.23
    • Work GPCI 1.000 changed to 1.002
    • Practice expense GPCI 0.990 changed to 0.984
    • Malpractice GPCI 0.826 changed to 0.755

  5. January 1, 2023

    RVU23A

    $122.26changed to$118.64

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 1.10 changed to 1.08
    • Malpractice RVU 0.21 changed to 0.22
    • Practice expense GPCI 0.995 changed to 0.990
    • Malpractice GPCI 0.897 changed to 0.826

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $122.93changed to$122.26

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 1.09 changed to 1.10

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $124.88changed to$122.93

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 1.03 changed to 1.09
    • Practice expense GPCI 0.991 changed to 0.995
    • Malpractice GPCI 0.903 changed to 0.897

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $123.52changed to$124.88

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 1.01 changed to 1.03
    • Malpractice RVU 0.20 changed to 0.21
    • Practice expense GPCI 0.986 changed to 0.991
    • Malpractice GPCI 0.908 changed to 0.903

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $123.74changed to$123.52

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 1.02 changed to 1.01

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $123.02changed to$123.74

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense GPCI 0.985 changed to 0.986
    • Malpractice GPCI 0.866 changed to 0.908

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $122.06changed to$123.02

    • Conversion factor 35.8043 changed to 35.8887
    • Malpractice RVU 0.19 changed to 0.20
    • Practice expense GPCI 0.983 changed to 0.985
    • Malpractice GPCI 0.824 changed to 0.866

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $122.51changed to$122.06

    • Conversion factor 35.9335 changed to 35.8043

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $121.90changed to$122.51

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $121.15changed to$121.90

    • Conversion factor 35.8228 changed to 35.7547
    • Malpractice RVU 0.17 changed to 0.19
    • Practice expense GPCI 0.980 changed to 0.983
    • Malpractice GPCI 0.778 changed to 0.824

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $118.26changed to$121.15

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 1.12 changed to 1.02
    • Malpractice RVU 0.18 changed to 0.17
    • Practice expense GPCI 0.977 changed to 0.980
    • Malpractice GPCI 0.731 changed to 0.778

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $118.26

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$130.81$97.65RVU26D
2026-07-01$130.81$97.65RVU26C
2026-04-01$130.81$97.65RVU26B
2026-01-01$130.81$97.65RVU26A
2025-10-01$113.38$100.97RVU25D
2025-07-01$113.38$100.97RVU25C
2025-04-01$113.38$100.97RVU25B
2025-01-01$113.38$100.97RVU25A
2024-10-01$116.86$103.76RVU24D
2024-07-01$116.86$103.76RVU24C
2024-04-01$116.86$103.76RVU24B
2024-03-09$116.86$103.76RVU24AR
2024-01-01$114.95$102.06RVU24A
2023-10-01$118.64$105.89RVU23D
2023-07-01$118.64$105.89RVU23C
2023-04-01$118.64$105.89RVU23B
2023-01-01$118.64$105.89RVU23A
2022-10-01$122.26$109.17RVU22D
2022-07-01$122.26$109.17RVU22C
2022-04-01$122.26$109.17RVU22B
2022-01-01$122.26$109.17RVU22A
2021-10-01$122.93$110.08RVU21D
2021-07-01$122.93$110.08RVU21C
2021-04-01$122.93$110.08RVU21B
2021-01-01$122.93$110.08RVU21A
2020-10-01$124.88$113.08RVU20D
2020-07-01$124.88$113.08RVU20C
2020-04-01$124.88$113.08RVU20B
2020-01-01$124.88$113.08RVU20A
2019-10-01$123.52$112.51RVU19D
2019-07-01$123.52$112.51RVU19C
2019-04-01$123.52$112.51RVU19B
2019-01-01$123.52$112.51RVU19A
2018-10-01$123.74$112.74RVU18D
2018-07-01$123.74$112.74RVU18C
2018-04-01$123.74$112.74RVU18B
2018-01-01$123.74$112.74RVU18AR1
2017-10-01$123.02$112.42RVU17D
2017-07-01$123.02$112.42RVU17C
2017-04-01$123.02$112.42RVU17B
2017-01-01$123.02$112.42RVU17A
2016-10-01$122.06$111.51RVU16D
2016-07-01$122.06$111.51RVU16C
2016-04-01$122.06$111.51RVU16B
2016-01-01$122.06$111.51RVU16A
2015-10-01$122.51$111.91RVU15D
2015-07-01$122.51$111.91RVU15C
2015-04-01$121.90$111.35RVU15B
2015-01-01$121.90$111.35RVU15A
2014-10-01$121.15$110.62RVU14D
2014-07-01$121.15$110.62RVU14C
2014-04-01$121.15$110.62RVU14B
2014-01-01$121.15$110.62RVU14A
2013-10-01$118.26$107.29RVU13D
2013-07-01$118.26$107.29RVU13C
2013-04-01$118.26$107.29RVU13B
2013-01-01$118.26$107.29RVU13AR

Price 99292 for an earlier date of service

Where the Virginia rate applies

Virginia is a Medicare payment area, not a city. Our Census mapping connects it to 628 cities and communities in Virginia. Some span more than one payment area; confirm with the service ZIP.

  • Abbs Valley
  • Abingdon
  • Accomac
  • Adwolf
  • Afton
  • Alberta
  • Aldie
  • Allison Gap

Browse all communities in Virginia

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

Show the CMS file lines behind this rate
RVUs for 99292PPRRVU2026_Oct_nonQPP.csv, line 13,044 (RVU26D)
Geographic factors for VirginiaGPCI2026.csv, line 106 (RVU26D)

Open CMS sourceHow we calculate rates

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