Critical care first hour
Medicare reimbursement rate, typical hospital charges, and what you should pay for CPT code 99291.
Medicare Rate
(Non-facility / office)
$274.56
2025 national average
Medicare Rate
(Facility / hospital)
$210.86
Physician portion only
Medicare OPPS Rate
(Outpatient facility)
$842.61
2025 outpatient rate
Typical Hospital Charge
(Uninsured / chargemaster)
$824.00–$2,196.00
3x–8x above Medicare
What is CPT Code 99291?
Critical care, first 30–74 minutes. Billed when a physician provides critical care to a critically ill or injured patient — conditions requiring constant physician attention to prevent life-threatening deterioration (e.g., respiratory failure, septic shock, major trauma).
The Medicare reimbursement rate shown above is the amount the federal government has determined is a reasonable payment for this service. Hospitals and providers that participate in Medicare have agreed to accept these rates from Medicare patients.
Who typically bills this:Intensivist, ED physician, or specialist managing critical illness
Common Billing Errors for CPT 99291
- !Billed for patients on monitored floors who are serious but not critically ill
- !Time not documented in the medical record — critical care is time-based and requires documented start/stop or total minutes
- !Billed alongside other E&M codes on the same date without separate documentation
Red Flags on Your Bill
- ⚑Critical care billed for a patient in a regular medical floor room, not an ICU or critical care unit
- ⚑No start/stop time or total minutes in the physician's note
Negotiation Tips for CPT 99291
- 1Critical care is heavily audited — request the physician note showing the total time and critical care activities
- 2If the patient was in a step-down or monitored bed, not an ICU, verify that critical care criteria were truly met
- 399291 for 30–74 minutes; 99292 is billed in 30-minute increments beyond that — verify total time claimed
Codes That Often Appear With This One
These CPT codes commonly appear on the same bill. Review each one to spot potential bundling errors or duplicate charges.
Found CPT 99291 on Your Bill?
If you see CPT code 99291 on a hospital or medical bill, compare the charged amount to the Medicare rate above. If your bill shows a significantly higher charge, you may have grounds to negotiate.
- Note the amount charged for CPT 99291 on your itemized bill
- Compare it to the Medicare rate above — calculate the markup
- Call the billing department and use the Medicare rate as your anchor:“I see CPT code 99291 billed at [amount]. The Medicare rate for this procedure is $274.56. I'd like to discuss a fair adjustment.”
Is CPT 99291 on your bill at a fair price?
Upload your full bill and we'll compare every line item to Medicare rates — then generate a personalized script to negotiate it down.
Analyze My Full BillMedicare rates shown are based on the 2025 Medicare Physician Fee Schedule national averages. Actual rates vary by geographic locality. Typical hospital charge ranges are estimates based on published research and do not represent any specific hospital's prices. This page is for informational purposes only and does not constitute medical or legal advice.