Wiki Critical Care Billing


Flower Mound, TX
Best answers
CRitical care billing

if Provider A bills for 60 minutes of critical care time and provider B comes in later and bills for 45 minutes critical care, can i bill as:

99291: provider A
99292: provider B

i am aware that you can only bill under one provider but is that only for 99292 or is that for both codes?

critical care

Critical care codes are provider specific. If two separate providers did two separate CC encounters, then I'd bill the 99291 for each of them, for the first 30 minutes and any additional time with 99292 (as allowed by CPT).

You cannot mix critical care time for multiple providers or your documentation will not stand up to review and the prepayment edits will likely cause a claim denial since 99292 is an add-on code. Software will typically look for 99291 under the provider number first. If you split them, the 99292 will deny since the 99291 would be under another provider.

What about if there is a change of shift? NEO Dr A bills 99291 for his visit but there is a shift change mid day where NEO Dr B then comes and sees patient on his rounds within the same day. My Manager is telling me to bill DR B with a 99292 which I don't think is correct. Because we won't get paid if we bill Dr. B with another 99291 the Manager is telling me to bill the 99292. Any thoughts?