2025 CPT code 99291
(Active) Effective Date: N/A Evaluation and Management - Critical Care Services Feed
Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes.
Modifiers may be applicable to 99291. Common modifiers for this code include modifier 24 (Unrelated E/M Service During a Postoperative Period), modifier 25 (Significant, Separately Identifiable E/M Service on the Same Day), and modifier 57 (Decision for Surgery).
Medical necessity for critical care services requires that the patient's condition acutely impairs one or more vital organ systems such that there is a high probability of imminent or life-threatening deterioration. The services provided must be essential to stabilize the patient’s condition, treat organ system failure, or prevent further deterioration.
The physician is responsible for the direct delivery of medical care to the critically ill or injured patient. This involves high-complexity decision-making to assess, manipulate, and support vital organ system function(s), to treat single or multiple vital organ system failure, and/or to prevent further life-threatening deterioration of the patient’s condition. The physician must devote their full attention to the patient during the critical care period.Time spent may be at the bedside or elsewhere on the floor/unit as long as it is directly related to the individual patient's care (e.g., reviewing test results, discussing the patient's care with other medical staff, documenting critical care services).
In simple words: This code covers the doctor's work in managing a very sick or seriously injured patient's care for the first 30 to 74 minutes.This kind of care is for patients whose body systems, like breathing, heart function, or brain activity, are in danger of failing.It usually happens in a special area of the hospital like the ICU or emergency room. The doctor has to make complex decisions and closely monitor the patient's condition.
This code represents the first 30-74 minutes of critical care provided to a critically ill or critically injured patient. Critical care is defined as the direct delivery by a physician or other qualified healthcare professional of medical care for a patient with a critical illness or injury. A critical illness or injury acutely impairs one or more vital organ systems such that there is a high probability of imminent or life-threatening deterioration in the patient's condition.Critical care involves high-complexity decision-making to assess, manipulate, and support vital system function(s).This care is typically given in a critical care area, such as the coronary care unit (CCU), intensive care unit (ICU), pediatric intensive care unit (PICU), respiratory care unit (RCU), or the emergency department.
Example 1: A patient arrives at the emergency room with severe respiratory distress due to an asthma attack.The physician provides critical care services for 45 minutes, including intubation, ventilator management, and continuous monitoring of vital signs., A post-operative patient in the ICU develops septic shock.The physician provides critical care services for 60 minutes, including administering fluids and medications, monitoring blood pressure and oxygen saturation, and adjusting ventilator settings., A patient with acute renal failure is admitted to the CCU. The physician provides critical care for 35 minutes which includes ordering and interpreting labs, and adjusting medications.
Documentation should clearly demonstrate that the patient's condition meets the definition of critical illness or injury, and that the physician's services meet the definition of critical care. The total time spent providing critical care must be documented, including the start and end times.Documentation must support the medical necessity for the critical care services provided.Specific details about the patient’s condition, the interventions performed, and the patient’s response to treatment should be included. The location of where the time was spent as long as the physician was immediately available to the patient should be documented.Any separately reportable procedures or services should also be documented.
- Specialties:Critical care services may be provided by physicians in various specialties including, but not limited to: Critical Care Medicine, Pulmonology, Cardiology, Anesthesiology, Surgery, Emergency Medicine, and Nephrology.
- Place of Service:Critical care can be provided in a variety of places of service, most commonly Inpatient Hospital, Emergency Room - Hospital, and Intensive Care Unit.