Reimbursement
$106.21
Threshold
30m
2026 Status
Active
What is CPT Code 99292?
CPT 99292 is defined as: Critical care, evaluation and management of the critically ill or critically injured patient; each additional 30 minutes (List separately in addition to code for primary service 99291).
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
2.25
Physician Effort
PE (Non-Fac)
0.7
Practice Expense
Malpractice
0.23
Risk Factor
Total RVU
3.18
Note: [(Work RVU * Work GPCI) + (PE RVU * PE GPCI) + (MP RVU * MP GPCI)] * Conversion Factor
2026 CMS Policy Intelligence
cpt vs medicare time
Crucial 2026 Conflict: CPT allows G2214 at 75-104 min, while Medicare requires reaching 104 FULL minutes for the first 99292 unit.
efficiency shield
Exempt from -2.5% efficiency cut.
reimbursement stability
wRVU of 2.25 is exactly half of 99291, providing proportional compensation for additional time.
Administrative Framework
Global Period
000
Place of Service
NCCI Exclusions
Operational Requirements
minimum time
Must meet thresholds (see 2026 Medicare vs CPT rules)
staff type
Physician or other Qualified Health Care Professional (QHP)
frequency
Multiple units allowed per day based on time
add on codes
care plan requirement
Continuous management of critical organ failure beyond the first hour.
Compliance Checklist
Audit Defense
No specific audit defense elements defined.
2026 Update
Medicare is auditing the '104-minute' threshold for 99292 to prevent billing multiple units for short-duration crises.
Common Clinical Scenarios
CMS Eligibility: Critically ill patient requiring prolonged direct management. Acute
Target Specialties & Utilization
Typical Clinical Indications (ICD-10)
Billing Differentiation
VS 99291
99291 is the base code (first hour); 99292 is for each additional half-hour.
VS 99233
99233 is daily rounding for sicker patients; 99292 is the extension of a critical crisis.
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