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CMS RVU26D · Effective 2026-10-01

99291 in Redding

Office / nonfacility

$318.14

Base rate per service

Facility setting

$197.70

Base rate per service

Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.

Evaluation and management

About 99291: Initial critical care service

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.

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.

Where the value comes from

  • Work RVU4.50 · 49%
  • Practice expense (office) RVU4.29 · 46%
  • Malpractice RVU0.46 · 5%

5.8M

Medicare services in 2024 · #39 by national volume

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.

99291 compared with similar codes

Office rates for Redding, from the same CMS release.

99292

Critical care

Each additional 30 minutes

$136.56

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.

99285

ED visit

High complexity decision making

No office rate

Choose 99285 for a high-complexity ED visit when the patient's condition or documented critical care time does not support 99291.

99233

Hospital follow-up visit

Subsequent day, high complexity

No office rate

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.

99471

Pediatric critical care

Initial day, age 29 days–24 months

No office rate

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.

The same code, a different location

How does Redding compare?

In Bakersfield, the office rate for 99291 is $319.56—$1.42 higher than the $318.14 rate in Redding. Both use the same code, release and participation basis.

99291 across payment areas

Same release and payment basis · bars start at $0

  1. Redding · This locality

    $318.14

  2. Bakersfield

    $319.56

    $1.42 higher than Redding

  3. Chico

    $318.14

    The same base rate than Redding

  4. El Centro

    $318.22

    $0.08 higher than Redding

  5. Fresno

    $318.14

    The same base rate than Redding

  6. Hanford-Corcoran

    $318.14

    The same base rate than Redding

  7. Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty)

    $336.18

    $18.04 higher than Redding

Other payment areas listed in California appear first, followed by selected cross-country examples. The chart compares amounts, not distance.

Across 109 of 109 CMS payment localities with a supported office rate, 99291 ranges from $281.30 in Arkansas to $386.53 in Alaska*. This is a geographic range, not an average.

The code’s RVUs stay the same in these comparisons. Geographic adjustments to work, practice expense and malpractice change the dollar amount. A city name alone may not identify the payment area for a service address.

Compare all 108 other payment areas

  • Madera

    California · 99291

    Office

    $318.14

    Facility

    $197.70

    The same base rate than Redding for the office setting.

  • Merced

    California · 99291

    Office

    $318.14

    Facility

    $197.70

    The same base rate than Redding for the office setting.

  • Modesto

    California · 99291

    Office

    $318.14

    Facility

    $197.70

    The same base rate than Redding for the office setting.

  • Napa

    California · 99291

    Office

    $356.43

    Facility

    $211.60

    $38.29 higher than Redding for the office setting.

  • Oxnard-Thousand Oaks-Ventura

    California · 99291

    Office

    $333.45

    Facility

    $203.56

    $15.31 higher than Redding for the office setting.

  • Rest Of California

    California · 99291

    Office

    $318.14

    Facility

    $197.70

    The same base rate than Redding for the office setting.

  • Riverside-San Bernardino-Ontario

    California · 99291

    Office

    $323.16

    Facility

    $202.72

    $5.02 higher than Redding for the office setting.

  • Sacramento-Roseville-Folsom

    California · 99291

    Office

    $330.60

    Facility

    $202.80

    $12.46 higher than Redding for the office setting.

  • Salinas

    California · 99291

    Office

    $329.27

    Facility

    $201.91

    $11.13 higher than Redding for the office setting.

  • San Diego-Chula Vista-Carlsbad

    California · 99291

    Office

    $334.52

    Facility

    $203.09

    $16.38 higher than Redding for the office setting.

  • San Francisco-Oakland-Berkeley (Marin Cnty)

    California · 99291

    Office

    $373.67

    Facility

    $218.73

    $55.53 higher than Redding for the office setting.

  • San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty)

    California · 99291

    Office

    $373.15

    Facility

    $218.21

    $55.01 higher than Redding for the office setting.

  • San Jose-Sunnyvale-Santa Clara (San Benito Cnty)

    California · 99291

    Office

    $381.70

    Facility

    $223.24

    $63.56 higher than Redding for the office setting.

  • San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty)

    California · 99291

    Office

    $379.56

    Facility

    $221.10

    $61.42 higher than Redding for the office setting.

  • San Luis Obispo-Paso Robles

    California · 99291

    Office

    $324.30

    Facility

    $199.14

    $6.16 higher than Redding for the office setting.

  • Santa Cruz-Watsonville

    California · 99291

    Office

    $335.79

    Facility

    $202.28

    $17.65 higher than Redding for the office setting.

  • Santa Maria-Santa Barbara

    California · 99291

    Office

    $329.82

    Facility

    $201.69

    $11.68 higher than Redding for the office setting.

  • Santa Rosa-Petaluma

    California · 99291

    Office

    $339.01

    Facility

    $204.06

    $20.87 higher than Redding for the office setting.

  • Stockton

    California · 99291

    Office

    $318.14

    Facility

    $197.70

    The same base rate than Redding for the office setting.

  • Vallejo

    California · 99291

    Office

    $355.68

    Facility

    $210.85

    $37.54 higher than Redding for the office setting.

  • Visalia

    California · 99291

    Office

    $318.14

    Facility

    $197.70

    The same base rate than Redding for the office setting.

  • Yuba City

    California · 99291

    Office

    $318.14

    Facility

    $197.70

    The same base rate than Redding for the office setting.

  • Dc + Md/Va Suburbs

    District of Columbia · 99291

    Office

    $344.32

    Facility

    $214.87

    $26.18 higher than Redding for the office setting.

  • Miami

    Florida · 99291

    Office

    $338.33

    Facility

    $223.93

    $20.19 higher than Redding for the office setting.

  • Chicago

    Illinois · 99291

    Office

    $330.62

    Facility

    $220.19

    $12.48 higher than Redding for the office setting.

  • Manhattan

    New York · 99291

    Office

    $350.79

    Facility

    $223.10

    $32.65 higher than Redding for the office setting.

  • Alaska*

    Alaska · 99291

    Office

    $386.53

    Facility

    $269.49

    $68.39 higher than Redding for the office setting.

  • Alabama

    Alabama · 99291

    Office

    $284.38

    Facility

    $188.23

    $33.76 lower than Redding for the office setting.

  • Arkansas

    Arkansas · 99291

    Office

    $281.30

    Facility

    $186.91

    $36.84 lower than Redding for the office setting.

  • Arizona

    Arizona · 99291

    Office

    $302.30

    Facility

    $195.82

    $15.84 lower than Redding for the office setting.

  • Colorado

    Colorado · 99291

    Office

    $316.57

    Facility

    $199.65

    $1.57 lower than Redding for the office setting.

  • Connecticut

    Connecticut · 99291

    Office

    $326.22

    Facility

    $207.87

    $8.08 higher than Redding for the office setting.

  • Delaware

    Delaware · 99291

    Office

    $306.44

    Facility

    $197.87

    $11.70 lower than Redding for the office setting.

  • Fort Lauderdale

    Florida · 99291

    Office

    $323.24

    Facility

    $211.92

    $5.10 higher than Redding for the office setting.

  • Rest Of Florida

    Florida · 99291

    Office

    $310.38

    Facility

    $205.33

    $7.76 lower than Redding for the office setting.

  • Atlanta

    Georgia · 99291

    Office

    $314.79

    Facility

    $203.14

    $3.35 lower than Redding for the office setting.

  • Rest Of Georgia

    Georgia · 99291

    Office

    $296.43

    Facility

    $198.41

    $21.71 lower than Redding for the office setting.

  • Hawaii, Guam

    Hawaii · 99291

    Office

    $322.12

    Facility

    $197.18

    $3.98 higher than Redding for the office setting.

  • Iowa

    Iowa · 99291

    Office

    $287.51

    Facility

    $186.97

    $30.63 lower than Redding for the office setting.

  • Idaho

    Idaho · 99291

    Office

    $289.40

    Facility

    $188.30

    $28.74 lower than Redding for the office setting.

  • East St. Louis

    Illinois · 99291

    Office

    $313.07

    Facility

    $211.98

    $5.07 lower than Redding for the office setting.

  • Rest Of Illinois

    Illinois · 99291

    Office

    $305.14

    Facility

    $204.81

    $13.00 lower than Redding for the office setting.

  • Suburban Chicago

    Illinois · 99291

    Office

    $325.74

    Facility

    $212.88

    $7.60 higher than Redding for the office setting.

  • Indiana

    Indiana · 99291

    Office

    $290.60

    Facility

    $188.73

    $27.54 lower than Redding for the office setting.

  • Kansas

    Kansas · 99291

    Office

    $287.58

    Facility

    $188.24

    $30.56 lower than Redding for the office setting.

  • Kentucky

    Kentucky · 99291

    Office

    $291.75

    Facility

    $194.06

    $26.39 lower than Redding for the office setting.

  • New Orleans

    Louisiana · 99291

    Office

    $302.59

    Facility

    $199.19

    $15.55 lower than Redding for the office setting.

  • Rest Of Louisiana

    Louisiana · 99291

    Office

    $291.83

    Facility

    $194.58

    $26.31 lower than Redding for the office setting.

  • Metropolitan Boston

    Massachusetts · 99291

    Office

    $341.23

    Facility

    $210.02

    $23.09 higher than Redding for the office setting.

  • Rest Of Massachusetts

    Massachusetts · 99291

    Office

    $315.84

    Facility

    $200.13

    $2.30 lower than Redding for the office setting.

  • Baltimore/Surr. Cntys

    Maryland · 99291

    Office

    $325.46

    Facility

    $207.55

    $7.32 higher than Redding for the office setting.

  • Rest Of Maryland

    Maryland · 99291

    Office

    $310.92

    Facility

    $199.71

    $7.22 lower than Redding for the office setting.

  • Rest Of Maine

    Maine · 99291

    Office

    $291.69

    Facility

    $190.59

    $26.45 lower than Redding for the office setting.

  • Southern Maine

    Maine · 99291

    Office

    $302.00

    Facility

    $193.10

    $16.14 lower than Redding for the office setting.

  • Detroit

    Michigan · 99291

    Office

    $314.48

    Facility

    $208.44

    $3.66 lower than Redding for the office setting.

  • Rest Of Michigan

    Michigan · 99291

    Office

    $298.47

    Facility

    $198.15

    $19.67 lower than Redding for the office setting.

  • Minnesota

    Minnesota · 99291

    Office

    $302.30

    Facility

    $189.22

    $15.84 lower than Redding for the office setting.

  • Metropolitan Kansas City

    Missouri · 99291

    Office

    $299.86

    Facility

    $196.68

    $18.28 lower than Redding for the office setting.

  • Metropolitan St. Louis

    Missouri · 99291

    Office

    $302.11

    Facility

    $197.50

    $16.03 lower than Redding for the office setting.

  • Rest Of Missouri

    Missouri · 99291

    Office

    $288.78

    Facility

    $194.06

    $29.36 lower than Redding for the office setting.

  • Mississippi

    Mississippi · 99291

    Office

    $285.03

    Facility

    $190.42

    $33.11 lower than Redding for the office setting.

  • Montana**

    Montana · 99291

    Office

    $308.93

    Facility

    $199.04

    $9.21 lower than Redding for the office setting.

  • North Carolina

    North Carolina · 99291

    Office

    $293.81

    Facility

    $191.28

    $24.33 lower than Redding for the office setting.

  • North Dakota**

    North Dakota · 99291

    Office

    $299.83

    Facility

    $189.94

    $18.31 lower than Redding for the office setting.

  • Nebraska

    Nebraska · 99291

    Office

    $288.37

    Facility

    $186.94

    $29.77 lower than Redding for the office setting.

  • New Hampshire

    New Hampshire · 99291

    Office

    $312.91

    Facility

    $198.52

    $5.23 lower than Redding for the office setting.

  • Northern Nj

    New Jersey · 99291

    Office

    $342.40

    Facility

    $214.93

    $24.26 higher than Redding for the office setting.

  • Rest Of New Jersey

    New Jersey · 99291

    Office

    $329.64

    Facility

    $209.64

    $11.50 higher than Redding for the office setting.

  • New Mexico

    New Mexico · 99291

    Office

    $300.15

    Facility

    $199.39

    $17.99 lower than Redding for the office setting.

  • Nevada**

    Nevada · 99291

    Office

    $306.54

    Facility

    $196.54

    $11.60 lower than Redding for the office setting.

  • Nyc Suburbs/Long Island

    New York · 99291

    Office

    $358.83

    Facility

    $228.17

    $40.69 higher than Redding for the office setting.

  • Poughkpsie/N Nyc Suburbs

    New York · 99291

    Office

    $332.56

    Facility

    $212.23

    $14.42 higher than Redding for the office setting.

  • Queens

    New York · 99291

    Office

    $351.45

    Facility

    $221.56

    $33.31 higher than Redding for the office setting.

  • Rest Of New York

    New York · 99291

    Office

    $297.23

    Facility

    $192.84

    $20.91 lower than Redding for the office setting.

  • Ohio

    Ohio · 99291

    Office

    $296.62

    Facility

    $196.29

    $21.52 lower than Redding for the office setting.

  • Oklahoma

    Oklahoma · 99291

    Office

    $290.20

    Facility

    $192.07

    $27.94 lower than Redding for the office setting.

  • Portland

    Oregon · 99291

    Office

    $323.34

    Facility

    $201.25

    $5.20 higher than Redding for the office setting.

  • Rest Of Oregon

    Oregon · 99291

    Office

    $303.82

    Facility

    $194.37

    $14.32 lower than Redding for the office setting.

  • Metropolitan Philadelphia

    Pennsylvania · 99291

    Office

    $320.50

    Facility

    $206.11

    $2.36 higher than Redding for the office setting.

  • Rest Of Pennsylvania

    Pennsylvania · 99291

    Office

    $296.36

    Facility

    $195.49

    $21.78 lower than Redding for the office setting.

  • Puerto Rico

    Puerto Rico · 99291

    Office

    $310.30

    Facility

    $199.21

    $7.84 lower than Redding for the office setting.

  • Rhode Island

    Rhode Island · 99291

    Office

    $314.88

    Facility

    $201.37

    $3.26 lower than Redding for the office setting.

  • South Carolina

    South Carolina · 99291

    Office

    $295.76

    Facility

    $194.23

    $22.38 lower than Redding for the office setting.

  • South Dakota**

    South Dakota · 99291

    Office

    $298.76

    Facility

    $188.87

    $19.38 lower than Redding for the office setting.

  • Tennessee

    Tennessee · 99291

    Office

    $288.81

    Facility

    $188.92

    $29.33 lower than Redding for the office setting.

  • Austin

    Texas · 99291

    Office

    $315.82

    Facility

    $199.56

    $2.32 lower than Redding for the office setting.

  • Beaumont

    Texas · 99291

    Office

    $294.97

    Facility

    $194.97

    $23.17 lower than Redding for the office setting.

  • Brazoria

    Texas · 99291

    Office

    $305.49

    Facility

    $196.59

    $12.65 lower than Redding for the office setting.

  • Dallas

    Texas · 99291

    Office

    $307.56

    Facility

    $198.11

    $10.58 lower than Redding for the office setting.

  • Fort Worth

    Texas · 99291

    Office

    $306.32

    Facility

    $197.97

    $11.82 lower than Redding for the office setting.

  • Galveston

    Texas · 99291

    Office

    $306.52

    Facility

    $197.40

    $11.62 lower than Redding for the office setting.

  • Houston

    Texas · 99291

    Office

    $314.93

    Facility

    $205.82

    $3.21 lower than Redding for the office setting.

  • Rest Of Texas

    Texas · 99291

    Office

    $300.16

    Facility

    $195.88

    $17.98 lower than Redding for the office setting.

  • Utah

    Utah · 99291

    Office

    $298.79

    Facility

    $195.50

    $19.35 lower than Redding for the office setting.

  • Virginia

    Virginia · 99291

    Office

    $302.01

    Facility

    $193.98

    $16.13 lower than Redding for the office setting.

  • Virgin Islands

    United States Virgin Islands · 99291

    Office

    $310.30

    Facility

    $199.21

    $7.84 lower than Redding for the office setting.

  • Vermont

    Vermont · 99291

    Office

    $299.94

    Facility

    $191.15

    $18.20 lower than Redding for the office setting.

  • Rest Of Washington

    Washington · 99291

    Office

    $314.83

    Facility

    $199.12

    $3.31 lower than Redding for the office setting.

  • Seattle (King Cnty)

    Washington · 99291

    Office

    $346.19

    Facility

    $211.35

    $28.05 higher than Redding for the office setting.

  • Wisconsin

    Wisconsin · 99291

    Office

    $292.31

    Facility

    $187.03

    $25.83 lower than Redding for the office setting.

  • West Virginia

    West Virginia · 99291

    Office

    $296.81

    Facility

    $201.32

    $21.33 lower than Redding for the office setting.

  • Wyoming**

    Wyoming · 99291

    Office

    $304.96

    Facility

    $195.07

    $13.18 lower than Redding for the office setting.

See how rates vary across the country

99291 · Office / nonfacility · Non-QP. Choose a state to explore its payment localities. A range means the amount varies within that state.

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 all state and territory rates as a table
State / territoryRate 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

Explore 99291 on the national rate map →

Where does this rate apply?

Redding is a Medicare payment area. Our Census mapping connects it to 32 cities and communities in California, including the examples shown here.

Some communities span more than one payment area. Follow a city link to compare all of its mapped areas, or check the service-location ZIP above for an address-level starting point.

Browse all communities in California →

Why are the office and facility amounts different?

For 99291 in Redding, the physician’s office rate is $318.14 and the facility-setting rate is $197.70: a difference of $120.44.

The calculation uses a different practice-expense RVU for each setting. Both amounts here are physician fee-schedule amounts. The facility figure does not include a hospital’s separate charges, so this comparison does not tell you the total cost of receiving care in each setting.

See the inputs behind this difference →

Use this rate

What is a percentage of Medicare worth?

Turn a percentage into dollars for 99291 in Redding. This uses the base rate on this page, so the locality and release stay consistent.

Reference amount per service

$349.95

$318.14 × 110% = $349.95

A contract may specify another Medicare year or additional adjustments. This is percentage arithmetic on the displayed base rate, not a claim adjudication.

Working with a whole code list?

Compare an offer across your annual code mix, including an older Medicare schedule or flat per-code rates.

Compare your contract offer →

How this local rate is calculated

Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 99291 in Redding.

PPRRVU2026_Oct_nonQPP.csv

13,043

Code
99291
Physician work
4.50
Practice expense
4.29
Malpractice
0.46

GPCI2026.csv

19

Locality
Redding
Physician work
1.017
Practice expense
1.096
Malpractice
0.536
Office / nonfacility calculation for 99291 in Redding
ComponentRVULocality factorAdjusted
Physician work4.50× 1.0174.5765
Practice expense4.29× 1.0964.7018
Malpractice0.46× 0.5360.2466
Total RVUs9.5249
Conversion factor× 33.4009

Office / nonfacility rate, Redding$318.14

Values as parsed from CMS release RVU26D, effective 2026-10-01. The amount is rounded to the nearest cent only at the end.

Open 99291 in the RVU calculator →

Explore RVUs, geographic factors and the full formula

Office / nonfacility

Office / nonfacility calculation inputs
ComponentRVULocal GPCI
Work4.51.017
Practice expense4.291.096
Malpractice0.460.536

(4.5 × 1.017 + 4.29 × 1.096 + 0.46 × 0.536) × $33.4009 = $318.14

Facility

Facility calculation inputs
ComponentRVULocal GPCI
Work4.51.017
Practice expense11.096
Malpractice0.460.536

(4.5 × 1.017 + 1 × 1.096 + 0.46 × 0.536) × $33.4009 = $197.70

The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.

How this rate has changed

99291 · Office / nonfacility

$318.14

Effective 2026-10-01

The base rate is $46.96 higher than on 2025-10-01, moving from $271.18 to $318.14 (17.3%).

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

    $271.18changed to$318.14

    • Conversion factor 32.3465 changed to 33.4009
    • Practice expense RVU 3.27 changed to 4.29
    • Malpractice RVU 0.44 changed to 0.46
    • Work GPCI 1.014 changed to 1.017
    • Practice expense GPCI 1.093 changed to 1.096
    • Malpractice GPCI 0.560 changed to 0.536

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    Earliest loaded release: $271.18

    Held through RVU25B, RVU25C, RVU25D.

Explore release dates and calculate this code in an earlier period →

Each row uses the accepted CMS release effective on that date and the same contractor and locality identifiers. Missing rates stay visible. Historical boundaries may differ; verify the service address for an older claim.

Inspect every release and its CMS source
Effective fromOffice / nonfacilityFacilityCMS release
2026-10-01$318.14$197.70RVU26D
2026-07-01$318.14$197.70RVU26C
2026-04-01$318.14$197.70RVU26B
2026-01-01$318.14$197.70RVU26A
2025-10-01$271.18$205.77RVU25D
2025-07-01$271.18$205.77RVU25C
2025-04-01$271.18$205.77RVU25B
2025-01-01$271.18$205.77RVU25A

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. CPT 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 indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.

Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.

RVUs for 99291PPRRVU2026_Oct_nonQPP.csv, line 13,043 (RVU26D)
Geographic factors for ReddingGPCI2026.csv, line 19 (RVU26D)
Open CMS sourceHow this rate is calculatedBuild a fee sheet