What is CPT code 99292?

CPT code 99292 is used by healthcare providers to document and receive reimbursement for critical care services involving each additional 30 minutes of evaluation and management for a critically ill or injured patient.

What factors affect CPT 99292 fee schedules?

Key factors affecting CPT 99292 fee schedules include Medicare & Medicaid rates, private insurance negotiated rates, geographic location, and provider type (e.g., hospital vs. private practice).

How can I find out the cost of a medical procedure before I have it?

To understand the cost of a medical procedure beforehand, you typically need to know the specific CPT (Current Procedural Terminology) code for the service. You can ask your doctor or the facility for this code. Once you have it, you can use online tools to estimate costs. For a comprehensive and specific search based on CPT code and location, Payerprice offers a fee schedule lookup tool that can provide detailed pricing information. It's also advisable to contact your insurance provider directly to understand your out-of-pocket costs, deductibles, and co-pays.

What is a CPT code, and why is it important for understanding healthcare costs?

A CPT (Current Procedural Terminology) code is a five-digit numerical code used by healthcare providers to describe medical, surgical, and diagnostic services. Each CPT code corresponds to a specific service or procedure. They are crucial for understanding healthcare costs because they standardize the reporting of medical services. When you have the CPT code, you can use it to accurately search for estimated prices for that specific service, verify coverage with your insurance, and compare costs across different providers or facilities using tools like Payerprice.

Where can I find information about standard healthcare prices?

Standard healthcare prices are not always straightforward to find due to variations based on insurance plans, providers, and geographic location. However, several resources can help. Hospital websites sometimes publish their standard charges, and your insurance company can provide estimates based on your plan. For a more direct and specific approach, Payerprice offers a fee schedule lookup tool where you can search for prices using CPT codes and your specific location, providing more tailored and actionable cost information.

Is there a tool to help me compare prices for medical services in my area?

Yes, there are tools available to help compare prices for medical services. For users looking to search for specific procedure costs based on CPT codes and their exact location, Payerprice provides a dedicated fee schedule lookup tool. This tool allows you to input a CPT code and location to find relevant pricing information, helping you make informed decisions about your healthcare. Additionally, some insurance companies offer price comparison tools for their network providers.

Why do healthcare prices vary so much?

Healthcare prices can vary significantly due to a multitude of factors, including: - **Negotiated Rates:** Insurers negotiate different rates with various hospitals and providers. - **Geographic Location:** Costs can differ based on the region, city, or even neighborhood due to local market dynamics and cost of living. - **Provider Type:** Academic medical centers, private practices, and outpatient clinics often have different pricing structures. - **Ancillary Services:** The total bill can include costs for supplies, facility fees, and other services not directly tied to the primary procedure. - **Market Competition:** The level of competition among healthcare providers in an area can influence pricing. - **Lack of Transparency:** Historically, price transparency has been limited, leading to less consumer power in negotiating costs. Tools like Payerprice aim to bring more transparency to these varying costs by providing accessible fee schedule information.

CPT 99292 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 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)

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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
Medicare Fee Schedule	View Medicare rates for 99292
Medicaid Fee Schedule	View Medicaid rates for 99292

National average reimbursement for CPT 99292 by major payers:

$149.49

$150.68

$156.95

$186.16

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, 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 Check Rates
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 Check Rates
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 Check Rates
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) Check Rates

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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