Reimbursement
$211.09
Threshold
30m
2026 Status
Active
What is CPT Code 99291?
CPT 99291 is defined as: Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes (time must be spent in the management of a patient whose illness or injury acutely impairs one or more vital organ systems such that there is a high probability of imminent or life-threatening deterioration).
This code is primarily used for E/M services. It falls under the category of Hospital Inpatient/Observation & Emergency Department and is valid for the 2026 calendar year according to the CMS Physician Fee Schedule.
2026 RVU Components
Relative Value Units (Non-Facility)
Work RVU
4.5
Physician Effort
PE (Non-Fac)
1.4
Practice Expense
Malpractice
0.42
Risk Factor
Total RVU
6.32
Note: [(Work RVU * Work GPCI) + (PE RVU * PE GPCI) + (MP RVU * MP GPCI)] * Conversion Factor
2026 CMS Policy Intelligence
high intensity reward
维持较高的 wRVU (4.5) 以补偿 ICU 和抢救室的高压力高风险工作。
efficiency shield
Exempt from -2.5% efficiency cut.
time unification
2026 guidelines emphasize 'Total Time' excluding procedures that are not bundled (e.g., intubation 31500 is NOT included in 99291 time).
Administrative Framework
Global Period
000
Place of Service
NCCI Exclusions
Key Modifiers
Operational Requirements
minimum time
30 minutes (must be documented explicitly)
staff type
Physician or other Qualified Health Care Professional (QHP)
frequency
Once per day per specialty (use 99292 for additional time)
add on codes
99292
care plan requirement
Immediate management of life-threatening organ system failure; continuous presence in the unit/facility.
Compliance Checklist
Audit Defense
No specific audit defense elements defined.
2026 Update
Medicare's '104-minute rule' for 99291 + 99292 remains strict – ensure Medicare patients hit the full 104-minute mark before billing the second unit.
Common Clinical Scenarios
CMS Eligibility: 1+ acutely impaired vital organ system with high risk of deterioration. Acute
Target Specialties & Utilization
Typical Clinical Indications (ICD-10)
Billing Differentiation
VS 99285
99285 is for high threat but not necessarily unstable/critical system failure yet.
VS 99292
99292 is an add-on for each additional 30 minutes after the first 74 minutes.
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