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See a sample rate comparisonCPT 99291 Fee Schedule
Last Verified: September 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
Critical Care Evaluation And, Critical Care Evaluation And Management Of The Unstablecritically Ill Or Unstable Critically Injured Patient Requiring The Constant Attendance Of The Physician First
| Key Fact | Detail |
|---|---|
| Service Type | Evaluation and Management Critical Care Services |
| Common Place of Service | 21 - Inpatient Hospital 23 - Emergency Room |
| Common Modifiers | None 25 - Significant, separately identifiable E/M service same day GC - Service performed by resident under supervision |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 99291 |
| Medicaid Fee Schedule | View Medicaid rates for 99291 |
National average reimbursement for CPT 99291 by major payers:
$323.91
$337.46
$354.81
$419.55
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CPT 99291
5 of 25 sample ratesHigher to lower in this preview
Nathan Swenson
Michelle Christensen
$1,137.92Published rateTravis W. Martin, M.D. P.C.
Travis W. Martin M.D., P.C.
$579.90Published rateKasey Conklin
Riverside Healthcare Association Inc
$487.10Published rateChristopher Waasdorp
Carilion Rockbridge Community Hospital
$433.79Published rateBilal Fiaz
$226.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 99291 vs. Other Critical Care Services Codes
The CPT 99291 code is part of the Evaluation and Management services used for Critical Care Services. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 99291 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 99285-CPT | High | Emergency Department Visit For, Emergency Department Visit For The Evaluation And Management Of A Patient Which Requires These 3 Key Components Within The Constraints Imposed By Theurgency Of The Patients Clinical Condition Ando |
| 99288-CPT | Low | Physician Or Other Qualified H, Physician Or Other Qualified Health Care Professional Direction Of Emergency Medical Systems (Ems) Emergency Care Advanced Life Support |
| 99291-CPT | Moderate | Critical Care Evaluation And, Critical Care Evaluation And Management Of The Unstablecritically Ill Or Unstable Critically Injured Patient Requiring The Constant Attendance Of The Physician First |
| 99292-CPT | Low | Critical Care Addl 30 Min, 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) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 99291. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99291 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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