CPT 99291: Critical care, first 30-74 min
What this code means, what it should cost, and how to dispute an overcharge.
Fair Price Reference
What is CPT 99291?
Critical care, first 30–74 minutes. Used when the patient is critically ill and the physician is continuously managing resuscitation, organ failure, or life-threatening instability.
Typical setting: ICU, ER, or inpatient setting.
What CPT 99291 should cost
The Centers for Medicare & Medicaid Services (CMS) pays approximately $445 for CPT 99291 under the 2025 Physician Fee Schedule. This is what the federal government has determined is a reasonable payment for this service.
Private insurance typically pays 1.2–1.8x Medicare rates ($534–$801). Hospital chargemaster prices for CPT 99291 often range from $800 to $2500 — a markup of 1.8x to 5.6x over Medicare.
Common overcharges on CPT 99291
Critical care time must be continuously documented. Request the bedside time log. If the physician was not at the bedside for 30+ continuous minutes of critical care, this code is improper.
About Emergency billing
Emergency room visits are among the most overcharged medical services in the U.S. ER billing combines a physician E&M code with a hospital facility fee — and the facility fee alone can run $500 to $3,000.
Request the itemized bill (UB-04) and the ED physician's documentation. If the medical decision-making does not support the billed level, demand a downcode. Out-of-network ER billing above in-network rates is illegal under the No Surprises Act.
How to dispute a CPT 99291 overcharge
- Request the itemized bill. You are entitled to a detailed line-by-line bill showing every CPT code billed. Ask in writing.
- Compare to Medicare allowable. If the charge exceeds 150% of Medicare ($668), you have grounds to dispute.
- Request documentation. For E&M codes, ask for the visit note. For procedures, ask for the operative report. The documentation must justify the code billed.
- Send a formal dispute letter. Cite the specific discrepancy between the documentation and the code. Reference Medicare rates and NCCI edits where applicable.
- Follow up in writing. Give the provider 30 days to respond. If they don't, escalate to the state attorney general and insurance commissioner.
Got CPT 99291 on your bill?
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