CPT Code 99291: Critical Care Services (First 30–74 Minutes)

What are critical care services (99291 CPT code)?

Critical care is the kind of constant, specialized medical attention given to patients whose organs are seriously failing or at risk of shutting down. These services are essential when someone’s condition is so unstable that they need to be closely monitored around the clock, because quick action can literally mean the difference between life and death.

The Current Procedural Terminology (CPT) 99291 code description is “critical care, evaluation and management of the critically ill or critically injured patient; first 30–74 minutes.” This code applies to the first 30 to 74 minutes of direct provider time spent managing a critically ill or injured patient. According to the American Medical Association (AMA), which maintains CPT as the standardized coding system for medical procedures, critical care requires that the clinician:

• Delivers hands‑on care to a patient with one or more vital organ system failure (e.g. renal, respiratory, central nervous system failure)
• Faces probability of imminent or life-threatening deterioration of the patient’s condition exists
• Engages in high complexity decision making to treat single or multiple vital organ system failure or to prevent further life-threatening deterioration of the patient’s condition requiring full attention

CPT 99291 is usually used for critical care services, often in places like the ICU or emergency department, but not always. In healthcare, it is vital to determine the correct critical care code to ensure that the intensity and complexity of critical interventions are properly documented and billed.  This particular code covers both the time spent and the tough decisions made to help stabilize and support seriously ill patients.

CPT Code 99291 documentation requirements

When it comes to 99291 CPT code reporting, here are the documents needed:

• Encounter context covering the medical necessity for critical care evaluation
• Relevant history, physical exam findings, and diagnostic results
• Medical plan of care detailing treatments, monitoring strategies, and timelines
• Documentation date, provider’s legible name, and clear rationale for any critical tests or procedures ordered
• Identification of pertinent health risk factors influencing urgent decision-making
• Record of patient progress, treatment responses, any adjustments, and diagnostic revisions within the documented total critical care time
• Consistency between the documented diagnoses, procedures, and the codes reported on the claim for CPT 99291

For split/shared critical care visits, performance and documentation requirements include who was involved, how much time each practitioner spent, and any time they worked together. Just remember, overlapping time can only be counted once. You also need to note what services were provided and make sure any time spent on other billable services is recorded separately so it’s clear it wasn’t part of the critical care time.

CPT code 99291 billing guidelines

When billing for critical care services, following established guidelines to ensure compliance and appropriate reimbursement helps ensure the correct use of the critical care codes and accurate billing practices.

Here are some considerations for CPT Code 99291:

• CPT code 99291 is used for critical care services provided for a total of 30 to 74 minutes. If the service time is less than 30 minutes, the appropriate evaluation and management (E/M) code should be reported instead. Remember how important it is to report the correct service code based on the time spent and the level of care provided.
• Certain services are bundled into critical care and cannot be billed separately, including things like cardiac output interpretation, chest X-rays, pulse oximetry, blood gases, ECGs, blood pressure monitoring, hematologic data, gastric intubation, temporary transcutaneous pacing, ventilator management, and vascular access procedures.
• CPT code 99291 can only be used once daily, even if the critical care time is not continuous. For additional critical care time with the same patient, CPT code 99292 should be used for each additional 30-minute increment. However, CPT code 99292 should not be reported until the total time spent reaches 104 minutes (74 minutes plus 30).

Other related critical care service codes

• 99292: 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)
• 99466: Critical care face-to-face services, during an interfacility transport of critically ill or critically injured pediatric patient, 24 months of age or younger; first 30-74 minutes of hands-on care during transport
• 99467: Critical care face-to-face services, during an interfacility transport of critically ill or critically injured pediatric patient, 24 months of age or younger; each additional 30 minutes (List separately in addition to code for primary service)
• 99468: Initial inpatient neonatal critical care, per day, for the evaluation and management of a critically ill neonate, 28 days of age or younger
• 99469: Subsequent inpatient neonatal critical care, per day, for the evaluation and management of a critically ill neonate, 28 days of age or younger
• 99471: Initial inpatient pediatric critical care, per day, for the evaluation and management of a critically ill infant or young child, 29 days through 24 months of age
• 99472: Subsequent inpatient pediatric critical care, per day, for the evaluation and management of a critically ill infant or young child, 29 days through 24 months of age