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Billing code 99291: Critical careMedicare rate & RVUs

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.

CMS RVU26DEffective Oct 1, 2026109 payment localities5.8M Medicare services in 2024

Medicare pays $308.96 for 99291 nationally in the office and $199.07 in a hospital or facility. Local office rates run $281.30–$386.53.

Medicare rate · 99291

Critical care

Swap in your local Medicare rate.

Work RVUs
4.5
Total RVUs
9.25
Global days
XXX

National rate · 2026

$308.96

Office setting, before claim adjustments.

See every locality for 99291 → · Billed by an NP, PA or therapist? →

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

On this page 10 sections
  1. Medicare rate
  2. What 99291 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

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

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

109 payment localities

$281.30 to $386.53

$281.30$333.91$386.53
One dot per payment locality, office / nonfacility. Hover a dot to see the locality; select it to open that rate.

109 of 109 payment localities

99291 office and facility rates by payment locality
Payment localityOfficeFacility
Alabama$284.38$188.23
Alaska*$386.53$269.49
Arizona$302.30$195.82
Arkansas$281.30$186.91
Atlanta$314.79$203.14
Austin$315.82$199.56
Bakersfield$319.56$199.12
Baltimore/Surr. Cntys$325.46$207.55
Beaumont$294.97$194.97
Brazoria$305.49$196.59

99291 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.

$281.30

$386.53

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

View every state and territory as a table
99291 office rate range by state
State / territoryOffice rate rangeLocalities
AK$386.531
AL$284.381
AR$281.301
AZ$302.301
CA$318.14–$381.7029
CO$316.571
CT$326.221
DC$344.321
DE$306.441
FL$310.38–$338.333
GA$296.43–$314.792
GU$322.121
HI$322.121
IA$287.511
ID$289.401
IL$305.14–$330.624
IN$290.601
KS$287.581
KY$291.751
LA$291.83–$302.592
MA$315.84–$341.232
MD$310.92–$344.323
ME$291.69–$302.002
MI$298.47–$314.482
MN$302.301
MO$288.78–$302.113
MS$285.031
MT$308.931
NC$293.811
ND$299.831
NE$288.371
NH$312.911
NJ$329.64–$342.402
NM$300.151
NV$306.541
NY$297.23–$358.835
OH$296.621
OK$290.201
OR$303.82–$323.342
PA$296.36–$320.502
PR$310.301
RI$314.881
SC$295.761
SD$298.761
TN$288.811
TX$294.97–$315.828
UT$298.791
VA$302.01–$344.322
VI$310.301
VT$299.941
WA$314.83–$346.192
WI$292.311
WV$296.811
WY$304.961

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

Swap in your local Medicare rate.

Work 4.50Practice expense 4.29Malpractice 0.46

9.2500 adjusted RVUs×$33.4009 conversion factor=$308.96

All indexes start 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).

Non-facility (office) rate · national

$308.96

The facility rate would be $199.07 (+$109.89). In a facility, the facility bills its own costs separately.

99291 compared with similar codes

Compare codes

99291 vs 99292 vs 99285 vs 99233 vs 99471: national Medicare rates

Swap in your local Medicare rate.

  • 99291
    Critical care · 4.5 wRVU
    $308.96
  • 99292
    Critical care · 2.25 wRVU
    $133.94−$175.02
  • 99285
    ED visit · 4 wRVU
    —
  • 99233
    Hospital follow-up visit · 2.4 wRVU
    —
  • 99471
    Pediatric critical care · 15.98 wRVU
    —

How to choose

99292Critical care
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 visit
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 visit
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 care
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.

Codes related to 99291

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

Codes related to 99291
CodeHow it relatesNational office range
Add-on codes
99292Critical careAdditional critical care time; Medicare requires 104 total minutes for the first add-on unit.$123.01–$171.39
Often billed with
99285ED visitA separately identifiable ED visit preceding deterioration may be reported with modifier 25 on the ED visit.No office rate
31500Emergency intubationEmergency intubation may be separately reported; exclude its time from critical care.No office rate
36556Central line insertionCentral venous catheter placement may be separately reported; exclude its time.$209.69–$317.01
92950CPRCPR may be separately reported; exclude its time from critical care.$338.96–$490.10
Used instead
99233Hospital follow-up visitSubsequent hospital visit when care does not meet the critical care condition or time requirements.No office rate
99471Pediatric critical careInitial inpatient pediatric critical care is reported per day for children aged 29 days through 24 months.No office rate

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. billing code 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
RVUs for 99291PPRRVU2026_Oct_nonQPP.csv, line 13,043 (RVU26D)

Open CMS sourceHow we calculate rates

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