Critical care first hour (99291) + each additional 30 min (99292)
99291 (critical care first 30-74 min) is reported first; 99292 is reported for each additional 30 minutes beyond 74 min.
Why this pair bundles
Add-on code 99292 cannot be reported without 99291 as the parent code.
Modifier-bypass policy
Modifier indicator: 0 — no modifier bypass is permitted for this pair under any circumstance.
Not a bundling issue — 99292 is an add-on code by design. Report 99291 once, then 99292 for each additional 30 min.
Documentation requirements
- Total critical care time documented
- Time-based note (e.g., 'Critical care time 105 minutes, exclusive of separately billable procedures')
Common clinical scenarios
- Sepsis management requiring 2+ hours of bedside attention
- Multi-organ failure intervention
Frequently asked questions
Why does CMS bundle 99291 and 99292?
Add-on code 99292 cannot be reported without 99291 as the parent code.
What documentation supports separate billing?
Total critical care time documented; Time-based note (e.g., 'Critical care time 105 minutes, exclusive of separately billable procedures').
When does this conflict typically arise?
Sepsis management requiring 2+ hours of bedside attention; Multi-organ failure intervention.
Sources
Catch NCCI 99291/99292 conflicts before submission
ApprovalHelp auto-flags NCCI bundling conflicts on the claim line before you submit. Modifier-bypass eligibility checked against current quarterly NCCI tables. no setup fee.
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