CPT 99292 Critical Care

Critical care, each additional 30 minutes Cost

Body System: General

Medicare Facility Rate

$111

CMS PFS CY2026

Medicare Non-Facility Rate

$153

Office/clinic setting

Relative Value Units (RVUs)

Medicare payment = Total RVU × Conversion Factor ($33.40 for CY 2026)

2.25

Work RVU

0.85

Facility PE RVU

0.32

Malpractice RVU

Cost by Location

Location	Medicare Rate	Est. Commercial
US — Carrier 01112 Locality 05	$111	$166 — $276
US — Carrier 01112 Locality 09	$112	$168 — $280
US — Carrier 01112 Locality 51	$107	$161 — $268
US — Carrier 01112 Locality 52	$111	$166 — $277
US — Carrier 01112 Locality 53	$107	$160 — $267
US — Carrier 01112 Locality 54	$101	$151 — $252
US — Carrier 01112 Locality 55	$100	$150 — $250
US — Carrier 01112 Locality 56	$100	$150 — $250
US — Carrier 01112 Locality 57	$100	$150 — $250
US — Carrier 01112 Locality 58	$100	$150 — $250
US — Carrier 01112 Locality 59	$100	$150 — $250
US — Carrier 01112 Locality 60	$100	$150 — $250
US — Carrier 01112 Locality 61	$100	$150 — $250
US — Carrier 01112 Locality 62	$103	$154 — $257
US — Carrier 01112 Locality 63	$103	$154 — $257
US — Carrier 01112 Locality 64	$102	$153 — $256
US — Carrier 01112 Locality 65	$113	$170 — $283
US — Carrier 01112 Locality 66	$102	$154 — $256
US — Carrier 01112 Locality 67	$103	$155 — $258
US — Carrier 01112 Locality 68	$100	$150 — $250

Frequently Asked Questions

How much does Critical care, each additional 30 minutes cost?

The Medicare facility rate is $111. Commercial insurance typically pays 150-250% of Medicare rates (varies).

How much does Critical care, each additional 30 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 $111.