Critical Care Time Billing: First 30 Minutes
The first 30 minutes of critical care time are NOT separately billable—you must provide at least 30 minutes of critical care services before you can bill CPT code 99291, which covers the first 30-74 minutes of critical care. 1, 2
Billing Structure for Critical Care Time
Initial Time Threshold
- CPT code 99291 requires a minimum of 30 minutes of critical care services before it can be billed 1, 2
- The first 30 minutes serve as the threshold requirement, not a separately billable unit 1
- This code covers 30-74 minutes of total critical care time 2
Additional Time Beyond Initial Period
- CPT code 99292 is used for each additional 30 minutes beyond the first 74 minutes 1
- This add-on code can only be billed after 99291 has been appropriately documented 1
Documentation Requirements
Medical Necessity Criteria
- The patient must meet the definition of "critically ill" as defined by Current Procedural Terminology: "a high probability of imminent or life-threatening deterioration in the patient's condition" 2
- Critical illness can be based on neurologic reasons even when cardiorespiratory status is stable 2
- Physicians must document the medical necessity and nature of critical illness because auditors may not understand the severity of neurologic conditions 2
Time Documentation
- Total time spent providing constant attention to the critically ill patient must be clearly documented 3
- Time must be continuous and dedicated to that specific patient's critical care 2
- Documentation should specify exact start and stop times to support the billing 2
Common Pitfalls to Avoid
Insufficient Time Documentation
- Billing 99291 for less than 30 minutes of documented critical care time will not withstand audit 2
- Vague time documentation (e.g., "approximately 30 minutes") is insufficient 2
Misunderstanding Critical Illness Definition
- Not all intensive care unit patients automatically qualify as "critically ill" for billing purposes 2
- The patient's condition, not the location of care, determines eligibility for critical care codes 2
Multiple Provider Billing Issues
- Specific rules govern whether multiple physicians can bill critical care codes for the same patient on the same day 2
- Coordination between providers is essential to avoid duplicate billing 2
Regional and Institutional Variations
- Cash prices for critical care time (99291) vary dramatically, ranging from $45 to $84,775 with a median of $1,816 1
- For-profit hospitals and those in the Western United States tend to charge significantly more for critical care services 1
- Large hospital systems, particularly Tenet Healthcare, charge substantially higher rates (median $28,244) 1