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Issue Number - Name
0063 - Excessive Units of Initial Critical Care
Review Type
Automated
Claim Type
Professional Services (Physician/Non-Physician Practitioner)
Region and State
RAC 1-4
All States
Date Approved
2017-09-06

Description

CPT Code 99291 is used to report the first 30-74 minutes of critical care on a given calendar date of service.  It should only be used once per calendar date, per beneficiary, by the same physician or physician group of the same specialty.

Affected Code(s)

  • CPT code 99291

Applicable Policy References

  • Title XVIII of the Social Security Act, Section 1833 (e)
  • Title XVIII of the Social Security Act, Section 1862 (a)(1)(A)
  • CMS Pub. 100-04, Medicare Claims Processing Manual, Chapter 12, Section 30.6.12 (F), (G), and (I)