CPT 99291 Critical Care
Critical care, first 30-74 minutes Cost
Body System: General
Medicare Facility Rate
$223
CMS PFS CY2026
Medicare Non-Facility Rate
$320
Office/clinic setting
Hospital Outpatient
$844
OPPS rate
Relative Value Units (RVUs)
Medicare payment = Total RVU × Conversion Factor ($33.40 for CY 2026)
4.50
Work RVU
1.75
Facility PE RVU
0.64
Malpractice RVU
Cost by Location
| Location | Medicare Rate | Est. Commercial |
|---|---|---|
| AK — ALASKA* | $299 | $449 — $749 |
| AL — ALABAMA | $214 | $320 — $534 |
| AR — ARKANSAS | $212 | $317 — $529 |
| AZ — ARIZONA | $225 | $338 — $563 |
| AZ — Phoenix | $228 | $342 — $570 |
| CA — BAKERSFIELD | $230 | $345 — $576 |
| CA — CHICO | $228 | $343 — $571 |
| CA — EL CENTRO | $228 | $343 — $571 |
| CA — FRESNO | $228 | $343 — $571 |
| CA — HANFORD-CORCORAN | $228 | $343 — $571 |
| CA — LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) | $240 | $360 — $600 |
| CA — Los Angeles | $244 | $366 — $610 |
| CA — MADERA | $228 | $343 — $571 |
| CA — MERCED | $228 | $343 — $571 |
| CA — MODESTO | $228 | $343 — $571 |
| CA — NAPA | $248 | $372 — $619 |
| CA — OXNARD-THOUSAND OAKS-VENTURA | $237 | $355 — $592 |
| CA — REDDING | $228 | $343 — $571 |
| CA — REST OF CALIFORNIA | $228 | $343 — $571 |
| CA — RIVERSIDE-SAN BERNARDINO-ONTARIO | $235 | $353 — $588 |
Frequently Asked Questions
How much does Critical care, first 30-74 minutes cost?
The Medicare facility rate is $223. Commercial insurance typically pays 150-250% of Medicare rates (varies). Hospital outpatient rate: $844.
How much does Critical care, first 30-74 minutes cost without insurance?
Without insurance, you may pay the hospital's chargemaster rate, which is often 300-500% of Medicare. Ask about cash-pay discounts — many facilities offer 20-40% off for self-pay patients. The Medicare baseline for this procedure is $223.