2025 CPT code 99292
(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; each additional 30 minutes (List separately in addition to code for primary service)
Modifiers may be applicable to further specify the circumstances of the critical care service provided. Refer to the provided list for applicable modifier options and descriptions.
Critical care is medically necessary when a patient has a critical illness or injury acutely impairing one or more vital organ systems with a high probability of imminent or life-threatening deterioration. The services provided must require the high-complexity decision-making of a physician to assess, manipulate, and support vital system functions.
The physician must devote their full attention to the patient and cannot provide services to any other patient during the same period. The time reported as critical care must be spent on work directly related to the patient's care, whether at the bedside or elsewhere on the unit (e.g., reviewing tests, discussing the patient's care with other staff, documenting services). Time spent with family or surrogate decision-makers can be included if the discussion directly relates to patient management.Time spent off the floor or unit, or in activities not directly contributing to the patient's treatment, is not billable as critical care.
In simple words: This code covers additional time spent by a doctor caring for a very sick patient who needs constant attention due to a severe illness or injury. This extra care goes beyond the initial period of treatment and is billed in 30-minute blocks.
This code represents each additional 30 minutes of critical care provided to a critically ill or critically injured patient beyond the initial 74 minutes.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).The purpose is to treat single or multiple vital organ system failure and/or to prevent further life-threatening deterioration of the patient's condition.This code is used in conjunction with 99291.
Example 1: A patient in the ICU with respiratory failure requires continuous monitoring and ventilator management. The physician spends 120 minutes providing critical care services. 99291 is billed for the first 74 minutes, and 99292 is billed twice for the additional 46 minutes., A patient admitted to the emergency department after a severe car accident has multiple organ system failures. The physician provides 90 minutes of critical care. 99291 is billed for the first 74 minutes, and 99292 is billed once for the additional 16 minutes., A patient post-major surgery develops complications requiring intensive care. The physician spends 2 hours (120 minutes) stabilizing the patient's condition. 99291 is billed for the first 74 minutes, and 99292 is billed twice for the additional 46 minutes.
Documentation must support the medical necessity of the critical care services and the time spent providing care.The total time, whether continuous or intermittent, must be documented in the patient record. This should include details of the patient's condition, interventions performed, and the physician's decision-making process.
** It is essential to consult the latest CPT and CMS guidelines for the most up-to-date information on critical care coding and reimbursement.
- Revenue Code: M2C
- Payment Status: Active
- Specialties:Critical care services can be provided by various specialists, including intensivists, anesthesiologists, cardiologists, pulmonologists, surgeons, emergency medicine physicians, and others depending on the patient's condition.
- Place of Service:Inpatient Hospital, Emergency Room - Hospital, and other critical care areas.