What is CPT Code 99291?
CPT 99291 represents Critical Care — First Hour. It is one of the most frequently abused billing codes in hospital medicine. Billed for patients who were never in critical condition.
When This Code Appears on Your Bill
You may have this code on your bill if you received any of the following:
- Standard ICU admission
- Post-surgery recovery
- Observation status
Critical care requires constant physician attention for a life-threatening condition. If your records show the physician visited once or twice during the hour, it's not critical care.
CPT 99291 Rate Comparison
Rate benchmarks for CPT 99291
You have the right to request an itemized bill and compare every CPT code against published Medicare rates. If you find CPT 99291 billed above the Medicare rate without justification, you can formally dispute the charge. Hospitals must respond within 30 days.
Found CPT 99291 on your bill?
Our auditors check this code — and every other line item — against Medicare rates and billing guidelines. Most bills with CPT 99291 have additional errors too.
Related CPT Codes to Check
If CPT 99291 appears on your bill, also check these commonly paired or confused codes:
How to Dispute a CPT 99291 Overcharge
- Request your itemized bill from the hospital billing department
- Look up CPT 99291 on cms.gov/medicare/physician-fee-schedule
- Calculate the difference between what you were charged and Medicare rate
- Write a formal dispute letter citing CPT 99291 and the specific dollar discrepancy
- Send via certified mail to Patient Financial Services
- Follow up on day 20 if no response — escalate to Patient Advocate if needed