What is Critical Care (First Hour) (CPT 99291)?

Intensive direct physician attendance managing acute organ failure or life-threatening illness. This clinical code is utilized across practices and hospitals for diagnostic and therapeutic service documentation.

What do doctors typically charge for Critical Care (First Hour)?

The nationwide median physician charge for Critical Care (First Hour) (CPT 99291) is $929.00. Doctor billed charges vary based on geographic region, setting, and overhead.

What is the standard insurance baseline for CPT 99291?

The standard insurance baseline reimbursement rate is $208.83. This represents the customary allowable amount established across standard fee schedules.

Home/Procedures/Critical Care (First Hour)

CPT 99291Critical Care

Critical Care (First Hour)

Intensive direct physician attendance managing acute organ failure or life-threatening illness. Clinical pricing breakdown and utilization metrics across 71,290 practicing doctors nationwide.

$929.00

Peer Median Charge

Gross billed rate

$208.83

Standard Baseline

Customary allowable

4.4x

National Markup

Charge vs baseline

71,290

Active Physicians

Billing this code

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Understanding This Medical Fee

Gross Charge vs Negotiated Payment: The median physician charge for this service is $929.00. However, insured patients almost never pay this full amount directly. Insurers negotiate rates down toward the $208.83 baseline.

Self-Pay & Uninsured Guidance: If you are paying without insurance or out-of-network, request a prompt-pay cash discount. Most medical practices are willing to settle self-pay bills near the customary baseline rate rather than the full gross charge.

Key Questions for Your Doctor's Billing Office:

"Does Dr. [Name] participate in my specific insurance plan network?"
"What is the total self-pay or cash rate for code 99291 if paid upfront?"
"Are there separate facility, anesthesia, or pathology fees associated with this procedure?"