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The ED Operator · Issue 2, late November 2026

Critical care 99291: the documentation that pays, and the 2027 numbers around it

Short answer: Medicare pays critical care on total time per practitioner per date: 99291 from 30 minutes, 99292 each additional 30, and aggregated or shared time needs 104 minutes for the first 99292. Procedure time out, modifier 25 on a same-day ED visit, FS on a shared visit. The CY2027 conversion factor is proposed to fall.
99291 · 30 to 74 minutes 99292 · each added 30 minutes FS · split or shared 25 · same-day ED visit

October 27, 20265 min readASP-RCM Solutions

Edition
Issue 2 · Nov 2026
Focus
Critical care
Codes
99291 · 99292
Metric
Total time per date
Horizon
CY 2027
Length
5 min read
30min
Minimum for 99291 on a date [1]
74min
Upper bound of the first unit
104min
Before the first 99292 when time is aggregated or shared
1per date
99291, however often the practitioner returns
Story 1 · The clock

99291 starts at 30 minutes; the first 99292 in a group needs 104

Critical care minutes on one date, manual section 30.6.12

Document total critical care time, not necessarily start and stop times; procedure time is excluded [1]. A note with no minutes supports nothing.

Under 30 minutesNo critical care code; report the appropriate E/M
30 to 74 minutes99291 once per date
After 74 minutes99292 per additional 30; aggregated or shared time needs 104 (74 + 30)
Total critical care time on the dateCodes reportedManual section
Under 30 minutesNo critical care code; report the appropriate E/M30.6.12.2
30 to 74 minutes99291 once30.6.12.2
Each additional 30 minutes after 7499292 per increment30.6.12.2
Same specialty, same group, several practitionersAggregate time to reach 99291; the first 99292 only when 104 total minutes are reached (74 + 30)30.6.12.4
Split (or shared) between physician and NPPBilling practitioner reports 99291 and, at 104 or more cumulative minutes, 99292; append modifier FS30.6.12.5
Story 2 · What is inside the code

Bundled services, the same-day ED visit, and the shared visit

Bundled services are not separately payable

Exclude: procedure time

  • Chest X-rays, pulse oximetry, blood gases, ECG interpretation, gastric intubation, transcutaneous pacing, ventilator management, vascular access
  • Separately reportable procedure time is excluded [1]

A same-day ED visit can be paid with modifier 25

Document: sequence

  • Record shows the visit came before the patient required critical care
  • Medically necessary, separate and distinct

Split or shared critical care uses modifier FS

Append: FS

  • Physician and NPP time in the same group is summed; jointly spent time counts once
  • The practitioner with more than half reports 99291 and any 99292
Payer rule that touches critical careWhat it saysWhy it matters in the ED
UHC ED facility policies 2026R6003A and 2026R6007ACritical care patients (99291, 99292) may be excluded from EDC Analyzer level adjustment [4]Critical care delivered but not billed exposes the level 5 to re-leveling
Cigna R30 (updated February 18, 2026)One E/M per provider per date; generally only the higher-RVU code is considered when both are billed [5]Same-day ED visit plus 99291 needs the modifier 25 record and an appeal path
Story 3 · The 2027 context

The conversion factor is proposed to fall; time-based codes stayed out of the 2026 efficiency cut

Medicare conversion factors, dollars per RVU

CY2026 set two factors, up from $32.35, and its -2.5 percent efficiency adjustment hit non-time-based services only, so critical care RVUs were not cut; facility PE RVUs fell for hospital-based specialties [2]. The July 14, 2026 proposed rule lowers the factors as the one-year 2.5 percent increase expires; final rule expected November 2026 [3].

CY2025single factor
$32.35baseline
CY2026, non-APMfinal
$33.40+3.2% vs 2025
CY2026, qualifying APMfinal
$33.57+3.8% vs 2025
CY2027, non-APMproposed
$32.84-1.68% vs 2026
CY2027, qualifying APMproposed
$33.17-1.19% vs 2026
CY2025CY2026 finalCY2027 proposed
Takeaway

Critical care is paid on documented minutes: total time per practitioner, procedure time out, modifier 25 with the sequence, FS on a shared visit.

One thing worth 30 minutes

Audit the last 20 99291 claims from your top payer for the clock

Total critical care time per practitioner statedMinutes on the note.
Procedure time excludedSeparately reportable procedures out.
Same-day ED visit carries modifier 25 with the sequenceThe visit came before the patient required critical care.
Shared visit carries FSOur emergency department billing services page carries the 104-minute rule and the payer leveling policies in one place; the pre-submit denial prediction engine scores every line against more than 80 CARC patterns.
Questions readers asked

Frequently asked questions

How many minutes are needed to bill 99291?

30 to 74 minutes of critical care by a single physician or NPP on a date, reported once per date even if the time is not continuous. Under 30 minutes, report the appropriate E/M code.

When can 99292 be billed in an emergency department?

For each additional 30 minutes after the first 74. When time is aggregated within a group or shared between a physician and an NPP, the first 99292 is reported only once 104 total minutes are reached.

Is the CY2027 conversion factor final?

No. CMS proposed $32.84 and $33.17 on July 14, 2026, down from $33.40 and $33.57. The final rule is expected in November 2026; re-check every figure against it.

Cited by name
  1. CMS Medicare Claims Processing Manual, Chapter 12, section 30.6.12, Critical Care Visits (99291 and 99292)
  2. CMS fact sheet, CY2026 Medicare Physician Fee Schedule final rule
  3. CMS fact sheet, CY2027 Medicare Physician Fee Schedule proposed rule (July 14, 2026)
  4. UnitedHealthcare Commercial Reimbursement Policy 2026R6003A, ED Facility E&M Coding Policy
  5. Cigna Reimbursement Policy R30, Evaluation and Management Services (updated February 18, 2026)

Checked October 25, 2026. Rules change; confirm against the source before relying on them.

Related reading
White paperED facility E/M leveling defense: EDC Analyzer and Anthem G-19002 Previous issueThe ED Operator, Issue 1: IDR batching changes on November 1 ServicesEmergency department billing services

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