CPT 99292
Global ZZZ ActiveCritical care addl 30 min
CPT 99292 Billing & Documentation Guide
CPT code 99292 (Critical care addl 30 min) is classified under E/M with a global period indicator of ZZZ. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 2.25, a non-facility practice expense RVU of 1.53, and a malpractice RVU of 0.23, a total non-facility RVU of 4.01 and facility RVU of 3. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $136.6, though rates vary from $123.01 to $171.39 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 99292, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify NCCI edits before bundling 99292 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
Add-on code (global concept does not apply)
MUE Limit (Medically Unlikely Edits)
Submitting more than 8 units of 99292 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
RVU Breakdown, CPT 99292
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 2.25 | 2.25 |
| Practice Expense RVU | 1.53 | 0.52 |
| Malpractice RVU | 0.23 | 0.23 |
| Total RVU | 4.01 | 3 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 99292
State-level averages across all MAC localities. Non-facility rates typically apply to office-based services; facility rates apply to hospital outpatient / inpatient.
| State | Non-Facility | Facility | Range (Non-Fac) | Localities |
|---|---|---|---|---|
| California | $142.48 | $102.56 | $136.56 - $161.23 | 29 |
| Florida | $141.38 | $107.53 | $135.55 - $147.78 | 3 |
| Georgia | $133.2 | $101.03 | $129.89 - $136.52 | 2 |
| Illinois | $139.48 | $106.88 | $133.82 - $144.67 | 4 |
| Michigan | $133.95 | $102.27 | $130.48 - $137.42 | 2 |
| North Carolina | $127.74 | $96.27 | $127.74 - $127.74 | 1 |
| New York | $146.17 | $108.54 | $129.1 - $154.99 | 5 |
| Ohio | $129.55 | $98.75 | $129.55 - $129.55 | 1 |
| Pennsylvania | $134.1 | $101.06 | $129.32 - $138.87 | 2 |
| Texas | $133.01 | $99.8 | $128.79 - $137.07 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
NCCI Bundling Edits, CPT 99292
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 99292 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 0188T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0189T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0359T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0360T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0361T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0362T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0362T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0363T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0364T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0365T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
Frequently Asked Questions, CPT 99292
What does CPT code 99292 mean? +
CPT code 99292 represents: Critical care addl 30 min. It's in the E/M category with a global period of ZZZ.
What is the Medicare reimbursement for CPT 99292? +
The 2026 Medicare national average non-facility payment for CPT 99292 is $136.6. Rates range from $123.01 to $171.39 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 99292? +
E/M codes commonly use modifier 25 (significant separately identifiable E/M on same day as a procedure), 57 (decision for major surgery), 24 (unrelated E/M during global period), 95 (synchronous audio+video telehealth), 93 (audio-only telehealth), and AI (principal physician of record on admission). Surgical modifiers like 50, 51, 59 do not apply to E/M.
What bundling edits apply to CPT 99292? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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