$124.22
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.
On this page
CMS RVU26D · Effective 2026-10-01
99291 Critical care Medicare reimbursement rates in Alabama
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. Compare 99291 office and facility rates across CMS payment localities in Alabama.
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.
What does Medicare pay for 99291 in Alabama?
Alabama has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
$284.38
1 of 1 localities have a supported rate.
Payment area: Alabama
One mapped payment locality.
Facility setting
$188.23
1 of 1 localities have a supported rate.
Payment area: Alabama
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
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 Alabama, from the same CMS release.
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.
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.
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.
Compare 99291 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Alabama →
Office / nonfacility
$284.38
Facility
$188.23
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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 Alabama.
PPRRVU2026_Oct_nonQPP.csv
13,043
- Code
- 99291
- Physician work
- 4.50
- Practice expense
- 4.29
- Malpractice
- 0.46
GPCI2026.csv
4
- Locality
- Alabama
- Physician work
- 1.000
- Practice expense
- 0.875
- Malpractice
- 0.566
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 4.50 | × 1.000 | 4.5000 |
| Practice expense | 4.29 | × 0.875 | 3.7538 |
| Malpractice | 0.46 | × 0.566 | 0.2604 |
| Total RVUs | 8.5141 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Alabama$284.38
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 4.5 | 1 |
| Practice expense | 4.29 | 0.875 |
| Malpractice | 0.46 | 0.566 |
(4.5 × 1 + 4.29 × 0.875 + 0.46 × 0.566) × $33.4009 = $284.38
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 4.5 | 1 |
| Practice expense | 1 | 0.875 |
| Malpractice | 0.46 | 0.566 |
(4.5 × 1 + 1 × 0.875 + 0.46 × 0.566) × $33.4009 = $188.23
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.
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.
13,04099284,,Emergency dept visit mod mdm,A,,2.74,0.45,NA,0.45,,0.35,3.54,3.54,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,04199285,,Emergency dept visit hi mdm,A,,4.00,0.65,NA,0.65,,0.48,5.13,5.13,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,04299288,,Direct advanced life support,B,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
13,04399291,,Critical care first hour,A,,4.50,4.29,,1.00,,0.46,9.25,5.96,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,04499292,,Critical care addl 30 min,A,,2.25,1.53,,0.52,,0.23,4.01,3.00,0,ZZZ,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,04599304,,1st nf care sf/low mdm 25,A,,1.50,0.84,,0.54,,0.09,2.43,2.13,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,04699305,,1st nf care moderate mdm 35,A,,2.50,1.54,,0.91,,0.18,4.22,3.59,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1ADDENDUM E. FINAL CY 2026 GEOGRAPHIC PRACTICE COST INDICES (GPCIs) BY STATE AND MEDICARE LOCALITY,,,,,,
2,,,,,,
3Medicare Administrative Contractor (MAC),State,Locality Number,Locality Name,2026 PW GPCI (with 1.0 Floor)***,2026 PE GPCI,2026 MP GPCI
410112,AL,00,ALABAMA,1.000,0.875,0.566
502102,AK,01,ALASKA*,1.500,1.065,0.551
603102,AZ,00,ARIZONA,1.000,0.969,0.856
707102,AR,13,ARKANSAS,1.000,0.859,0.515