{
    "code": "99291",
    "coding_system": "CPT",
    "canonical_url": "https://localishealth.com/cpt/99291/2024/A",
    "release_specific_url": "https://localishealth.com/cpt/99291/2024/C",
    "description": "Direct, intensive physician care of a patient whose illness or injury is acutely impairing one or more vital organ systems, with a real chance of rapid deterioration — septic shock, respiratory failure, major trauma, a severe overdose. It demands high-complexity decision making and the physician's full attention devoted to that one patient, to the exclusion of everyone else. This code covers the first block of critical care time in a day, running from half an hour up to about an hour and a quarter; a shorter encounter is reported as an ordinary visit instead, and longer ones bring in a companion add-on code. The time counted includes work at the bedside and time spent elsewhere on the unit devoted solely to that patient, such as reviewing test results or talking with family about treatment decisions.",
    "answer": {
        "question": "How much did Medicare pay for CPT 99291 in Q3 2024?",
        "text": "Medicare paid $272.29 for CPT 99291 in the office (non-facility) setting and $210.04 in a facility under the Q3 2024 Physician Fee Schedule, effective July 2024. These are the national allowed amounts before the ~2% sequestration cut and before locality (GPCI) adjustment. This price has been unchanged since Q1 2024, when it decreased 1.2%."
    },
    "release": {
        "schedule": "pfs",
        "year": 2024,
        "quarter": "C",
        "label": "Q3 2024",
        "effective": "July 1 – September 30, 2024",
        "revision": 1
    },
    "status": {
        "code": "A",
        "non_facility_payable": true,
        "facility_payable": true
    },
    "national_rates_usd": {
        "office_non_facility": 272.29,
        "facility": 210.04,
        "sequestration_applied": false,
        "gpci": 1
    },
    "rvus": {
        "work": 4.5,
        "practice_expense_non_facility": 3.26,
        "practice_expense_facility": 1.39,
        "malpractice": 0.42
    },
    "formula": "(work_rvu × work_gpci + pe_rvu × pe_gpci + mp_rvu × mp_gpci) × conversion_factor",
    "conversion_factor": 33.2875,
    "source": {
        "label": "Physician relative value file (Q3 2024)",
        "cms_url": "https://www.cms.gov/files/zip/rvu24c-updated-09/09/2024.zip",
        "local_source_url": "https://localishealth.com/sources/physician-fee-schedule/2024/C",
        "file": "PPRRVU24_JUL.csv",
        "row": 18535,
        "sha256": "63e2b9617ccd91e8ad68d5f23a0ae26a106d0cdfdf6390631fbac7b7e0513df1"
    },
    "modified_at": "2026-08-04T03:14:09+00:00"
}