critical care billing CPT 99291, 99292 AND its restriction

Critical Care (99291 & 99292)

When caring for a critically ill patient, for whom the constant attention of the physician is required, the appropriate critical care procedure code (99291 and 99292) must be billed. Critical care guidelines are defined in the Current Procedural Terminology (CPT) and Provider Manual. Critical care is considered a daily global inclusive of all services directly related to critical care.

Coverage of critical care may total no more than four hours per day. The actual time period spent in attendance at the patient's bedside or performing duties specifically related to that patient, irrespective of breaks in attendance, must be documented in the patient's medical record.

No individual procedures related to critical care may be billed in addition to procedure codes 99291 and 99292, except:

• An EPSDT screening may be billed in lieu of the initial hospital care (P/C 99221, 99222, or 99223). If screening is billed, the initial hospital care cannot be billed.

• Procedure code 99082 (transportation or escort of patient) may also be billed with critical care (99291 and/or 99292 for recipients 25 months of age and older or 99466 and/or 99467 for recipients
24 months of age or less). Only the attending physician may bill this service and critical care. Residents or nurses who escort a patient may not bill either service.

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