Accurate billing for CPT 99291 is imperative in anesthesiology, where critically ill patients demand precise, high-stakes care. This guide breaks down time-based billing units, anesthesiology-focused clinical scenarios, and payer-specific reimbursement insights to help ensure compliance, optimal revenue capture, and reduced audit risk.

Time‑Based Units for CPT 99291

• First Unit—99291: Billed when a physician or qualified provider delivers 30–74 minutes of critical care in one calendar day. This code can only be used once per patient per date of service.
  
  
• Additional Units—99292: For each additional 30‑minute block beyond 74 minutes, bill one unit of 99292 alongside the initial 99291. For example:
  
  
  
  • 75–104 min → 99291 + 1×99292
    
    
  • 105–134 min → 99291 + 2×99292
    
    
• Less than 30 minutes: Use a suitable E/M code such as 99232 or 99233—do not use 99291
  
  

Time may be non-continuous but must be meticulously documented and attributable to critical care activities. Only one provider at a time can bill for critical care, and each must be in a position to devote full attention to the patient.

Anesthesiology‑Focused Clinical Scenarios

In anesthesiology, billing CPT 99291 often aligns with high-risk intraoperative events:

Scenario examples:

• A patient develops severe intraoperative hypotension and arrhythmia, requiring immediate life-support interventions.
  
  
• Massive hemorrhage during surgery, requiring rapid transfusion, respirator support, and real‑time titration of vasoactive drugs.
  
  
• Unexpected cardiac arrest in the OR, necessitating CPR, advanced airway management, and immediate invasive monitoring.
  
  
• Post-anesthesia acute respiratory failure, needing urgent reintubation and ventilator management.
  
  

Time spent delivering these interventions—whether at the bedside, coordinating care, reviewing vital signs, or counseling anesthetic teams—counts toward critical care time. Documentation must clearly establish the time blocks, the critical condition, and the provider’s undivided attention.

Payer-Specific Reimbursement Rates*

Reimbursement for CPT 99291 varies:

Medicare Reimbursement (National Average)

• Non-facility (physician office/clinic) rate: $265.56 nationwide
• Facility rate (e.g., hospital setting): $205.72 nationwide

In-Network Commercial Payer Averages

Based on aggregated data from major insurers, the national average reimbursements are approximately:

• Blue Cross Blue Shield: $323.91
• United Healthcare: $337.46 
• Aetna: $354.81 
• Cigna: $419.55

It’s advisable for practices to verify payer-specific rates, as some contracts may also introduce modifiers, such as:

• Modifier 25: When critical care is provided in addition to a separately reportable E/M service.
  
  
• Modifiers 54/55/24/FT: Depending on whether critical care coincides with postoperative care or global surgical periods.
  
  

Final Takeaways

When providing and billing CPT 99291, meticulously document the total critical care time, ensuring it meets the 30‑minute threshold and clearly differentiates from separately billable procedures. Use 99292 appropriately for additional time blocks and capture true complexity, especially in anesthetic emergencies. Account for payer-specific rates by validating reimbursement levels and modifiers, and always align documentation with the high-stakes context of anesthesiology to support Medicare and commercial claims efficiently.

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