Hospital · CMS status A
99291
Critical care first 30-74 min
Critical care, evaluation and management of the critically ill or critically injured patient, first 30-74 minutes on a given date. CMS 2026 wRVU 4.50. The highest-paying inpatient E/M code; reserved for true critical care delivery.
Work RVU
4.50
2026 Medicare pays
$229.80
National GPCI · non-facility · CF $33.4009
RVU anatomyWork 4.50 + Practice 2.05 + Malpractice 0.33 = 6.88 total
Work (your effort)Practice expenseMalpractice
Billing guidance for 99291 is locked
- When to use it: the exact clinical situations that support billing 99291
- Documentation checklist: the 6 elements your note needs before submitting
- Common pitfalls: the 6 mistakes that get 99291 downcoded or denied
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Common modifiers
25
Common ICD-10 pairings
A41.9I46.9J96.01G40.901I26.99K72.10
Payer notes
Medicare and commercial payers pay 99291 at a significantly higher rate than the highest-MDM subsequent care code (99233 at 2.00 wRVU vs 99291 at 4.50 wRVU). Use the code only when documentation supports critical illness; the disparity drives aggressive auditing. CMS Comparative Billing Reports rank clinicians on 99291 rates relative to specialty peers. Documentation that names the at-risk organ system, the intervention, and the time meets the standard.
Pairs well with
Educational reference, not billing or legal advice. Verify against your payer contracts and your compliance team before submission.