CPT 99292 Fee Schedule
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.
| 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 | Low |
National average reimbursement for CPT 99292 by major payers:
$149.49
$150.68
$156.95
$186.16
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 99292 | ||||||
United | 99292 | $250.27 | 1215950258 - LEKHA SHAH | 581537752 - EMORY UNIVERSITY | GA | Emergency Medicine Physician (207P00000X) |
United | 99292 | $209.25 | 1154611614 - MANEESHA SABHARWAL | 581537752 - EMORY UNIVERSITY | GA | Emergency Medicine Physician (207P00000X) |
United | 99292 | $311.67 | 1487825782 - MATTHEW BEECROFT | 320261234 | WA | Emergency Medicine Physician (207P00000X) |
United | 99292 | $148.75 | 1508563578 - EAGLE MOUNTAIN HEALTHCARE LLC | 922269218 - (TX) EAGLE MOUNTAIN HEALTHCARE LLC | TX | Multi-Specialty Group (193200000X) |
United | 99292 | $259.01 | 1487628434 - HEEMUN KWOK | 911220843 - ASSOCIATION OF UNIVERSITY PHYSICIANS | WA | Emergency Medicine Physician (207P00000X) |
United | 99292 | $346.51 | 1407941859 - JOSHUA MICHAEL | 910565539 - (WA) VIRGINIA MASON MEDICAL CENTER | WA | Emergency Medicine Physician (207P00000X) |
United | 99292 | $295.72 | 1114931201 - BROOKS MOORE | 581537752 - EMORY UNIVERSITY | GA | Emergency Medicine Physician (207P00000X) |
United | 99292 | $181.28 | 1184251597 - JASMINE THOMPSON | 376000511 - THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS | LA | Emergency Medicine Physician (207P00000X) |
United | 99292 | $314.94 | 1063953313 - DANIEL MILLER | 391947472 | WI | Emergency Medicine Physician (207P00000X) |
United | 99292 | $171.91 | 1710285788 - STEVEN MAHON | 351747218 - INDIANA UNIVERSITY HEALTH CARE ASSOCIATES INC | IN | Emergency Medicine Physician (207P00000X) |
United | 99292 | $324.91 | 1326049420 - MOHAMMAD HASSAN | 420782518 - ALEGENT HEALTH MERCY HOSPITAL | KS | Emergency Medicine Physician (207P00000X) |
United | 99292 | $255.52 | 1538471339 - PATRICK MELOY | 204700877 | GA | Emergency Medicine Physician (207P00000X) |
United | 99292 | $233.82 | 1962769976 - IAN MAY | 911170922 - (WA) SEATTLE EMERGENCY PHYSICIANS SERVICES, INC., P.S. | WA | Emergency Medicine Physician (207P00000X) |
United | 99292 | $241.64 | 1336103357 - WILLIAM LEWIS | 561996922 - (NC) CAROLINA MTN EMERGENCY MEDICINE | NC | Emergency Medicine Physician (207P00000X) |
United | 99292 | $209.25 | 1700152279 - GEORGE HUGHES | 582030692 - EMORY UNIVERSITY | GA | Emergency Medicine Physician (207P00000X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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CPT 99292 vs. Other Critical Care Services Codes
The CPT 99292 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 99292 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 The Evaluation And Management Of A Patient Which Requires A Medically Appropriate History And/Or Examination And High Level Of Medical Decision Making (Desc Rvsd 1/1/23) |
| 99288-CPT | Low | Physician Or Other Qualified Health Care Professional Direction Of Emergency Medical Systems (Ems) Emergency Care Advanced Life Support (Revised 01/01/13) |
| 99291-CPT | Moderate | Citical Care, Evaluation And Management Of The Unstable Critically Ill Or Unstable Critically Injured Patient, Requiring The Constant Attendance Of The Physician; Ist Hour |
| 99292-CPT | Low | 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 99292. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99292 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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