Evaluation & management · General
Add-on code for each additional 30 minutes of critical care past the time covered by 99291 on the same date.
- Medicare
- $133.94
- Work RVU
- 2.25
- Global, days
- Region
- General
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 3 cited references ↓
- Total critical care time on the date, start and stop times or a clear total
- Ongoing critical condition requiring continued direct management
- Time on separately billable procedures excluded
- Same physician reported 99291 on that date
Applicable modifiers
Modifiers commonly billed with this code.
Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual
What this code covers
Source · Editorial summary grounded in 3 cited references ↓
99292 is the add-on for extra critical care time. It is never billed alone and must follow 99291 for the same physician on the same date.
CPT and Medicare count time differently. Under CPT rules, the first 99292 is reported once total time reaches 75 minutes. Medicare requires 104 minutes before the first unit, because it wants a full 30 minutes past the 74 minutes that 99291 can cover. For commercial claims, check whether the payer follows CPT or Medicare.
In orthopedic trauma, 99292 comes up with prolonged resuscitation of a polytrauma patient. Time on separately billed procedures, like a pelvic binder followed by external fixation in the OR, does not count. When a surgeon bills critical care in the global period for Medicare, modifier FT goes on both 99291 and 99292.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
Work RVU vs. total RVU
The work RVU (2.25) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (4.01) adds practice overhead and malpractice, and is what drives the Medicare payment below.
| Work RVU | 2.25 |
| Practice expense RVU | 1.53 |
| Malpractice RVU | 0.23 |
| Total RVU | 4.01 |
| Medicare national rate | $133.94 |
| Global period | days |
Payment by site of service
Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.
Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026
| Setting | Medicare rate (national) |
|---|---|
Office (PFS non-facility) Procedure performed in physician's office | $133.94 |
Common denial reasons
The recurring reasons claims for CPT 99292 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Billed without 99291 on the same claim
- Medicare threshold of 104 minutes not met
- Procedure time included in total
- Units billed exceed documented time
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 3 cited references ↓
01When can I bill the first unit of 99292 for Medicare?
02Can 99292 be billed without 99291?
03Does 99292 need modifier FT in a global period?
Sources & references
Editorial content was developed using the following public sources.
Mira Scribe
Mira Scribe records total critical care time and keeps procedure work separate, which makes the 99292 unit count easy to support.
See how Mira captures CPT 99292 documentation