Evaluation & management · General
Critical care for a critically ill or injured patient, covering the first 30 to 74 minutes of physician time on a date under CPT counting rules.
- Medicare
- $308.96
- Work RVU
- 4.5
- 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 ↓
- Nature of the critical illness or injury and the organ systems at risk
- Total critical care minutes, excluding time on separately billed procedures
- Interventions and decisions made
- Statement that time was spent directly managing the critical condition
- For surgeons in a global, why the critical care is unrelated to the routine postop course
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 ↓
99291 covers the first 30 to 74 minutes of critical care on a date. The patient must have a critical illness or injury that threatens life or organ function, and the physician must be making high-complexity decisions to treat it. Under 30 minutes, use the appropriate E/M instead.
In orthopedics this mostly comes from trauma: an unstable pelvic fracture with hemorrhage, a polytrauma patient with open femur fractures, or fat embolism after long bone fracture. Time spent on separately billed procedures, like an external fixator, does not count toward critical care time.
Surgeons need to watch the global period. For Medicare, critical care in the global is separately payable with modifier FT only when it is unrelated to the surgery that started the global. Routine postop care in the ICU is not critical care, even if the patient is in the unit.
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 (4.5) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (9.25) adds practice overhead and malpractice, and is what drives the Medicare payment below.
| Work RVU | 4.5 |
| Practice expense RVU | 4.29 |
| Malpractice RVU | 0.46 |
| Total RVU | 9.25 |
| Medicare national rate | $308.96 |
| 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 | $308.96 |
HOPD (APC 5041) Hospital outpatient department | $843.92 |
Common denial reasons
The recurring reasons claims for CPT 99291 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Total time under 30 minutes or not documented
- Procedure time counted toward critical care time
- Billed in a global period without modifier FT
- Patient in the ICU but not critically ill
- Same-day E/M by the same physician without modifier 25 when given before critical care began
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 3 cited references ↓
01How much time is required to bill 99291?
02Can an orthopedic surgeon bill critical care in the global period?
03Does time spent placing an external fixator count toward 99291?
04Can 99291 be billed more than once a day?
Sources & references
Editorial content was developed using the following public sources.
Mira Scribe
Mira Scribe records the patient's condition, the interventions, and the time spent, so the note supports critical care and stays separate from procedure time.
See how Mira captures CPT 99291 documentation