CMS Manual Update for Critical Care Time
By Nicole Benson, Gill Compliance Solutions
We have recently received a number of inquiries about the Medicare Claims Processing Manual update, issued February 2, 2023, for Section 30.6.12.5 pertaining to split (or shared) critical care visits. Although several topics were updated, the area that has caused the most confusion is the new time requirements in order to bill CPT code 99292, defined as each additional 30 minutes of critical care. The manual section excerpt states:
To bill split (or shared) critical care services, the billing practitioner first reports CPT code 99291, and, if 104 or more cumulative total minutes are spent providing critical care, the billing practitioner reports one or more units of CPT code 99292. Modifier -FS (split or shared E/M visit) must be appended to the claim's critical care CPT code(s).
Noridian also clarified in a February 3, 2023 article to say:
The full timeframe for each code must be met to add it to the claim. In critical care, after 74 minutes of cumulative time has been spent, meeting the requirement for CPT 99291, the billing practitioner may report one or more units of CPT 99292 only when another full 30 minutes have been spent (74 +30=104). Each 30-minute segment beyond that would support an additional unit of CPT 99292.
CMS now requires a full 30 minutes, above and beyond the cap of initial code CPT 99291 with a time requirement of 30-74 minutes, before adding 99292. This applies to single providers billing critical care along with the same group and split/shared. Although the single provider section in the claims manual did not have language changes, CMS did issue a change request to include all providers, regardless of the shared/split rules. Using the updated thresholds, the time increments would be as follows:
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