How much does Medicare pay for CPT 99292?

Medicare allowed an average of $102.73 per service and paid $81.92 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $442.68, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 99292?

Critical care, each additional 30 minutes. It was billed 261,841 times to 131,018 Medicare beneficiaries by 4,826 providers in 2024.

Does 99292 pay differently in an office than a hospital?

Yes. The allowed amount averaged $123.52 in an office setting and $102.68 in a facility. The office rate is generally higher because the practice supplies the room, staff and equipment out of that single payment; in a hospital those are billed separately by the facility.

Which specialty bills 99292 most?

Critical Care (Intensivists), with 54,687 services from 975 clinicians. Next are Nurse Practitioner, Pulmonary Disease, Emergency Medicine.

CPT 99292

Critical care, each additional 30 minutes

$102.73Medicare-allowed amount per service, averaged across 261,841 services

Providers submitted

$442.68

Asking price, not received

Medicare allowed

$102.73

The fee schedule figure

Medicare paid

$81.92

Balance is patient coinsurance

Providers submitted an average of $442.68 for this code and Medicare allowed $102.73 — 4.3× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $81.92 (80%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $123.52
Hospital / facility: $102.68

The office rate is higher because the practice supplies the room, staff and equipment out of that payment. In a hospital the facility bills those separately, so the clinician's share is smaller — the total cost to Medicare is usually higher, not lower. 600 services were billed in an office setting and 261,241 in a facility.

Services: 261,841
Beneficiaries: 131,018
Providers billing it: 4,826
Total allowed: $26,898,926

What Medicare pays for CPT 99292

Across 261,841 services billed by 4,826 providers to 131,018 beneficiaries, Medicare allowed an average of $102.73 per service. That is 2.0 services per beneficiary, so this is a code patients typically receive more than once. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 99292

Specialty	Services	Beneficiaries	Avg allowed	Providers
Critical Care (Intensivists)	54,687	27,674	$108.66	975
Nurse Practitioner	46,491	17,405	$89.23	635
Pulmonary Disease	44,890	23,964	$107.44	838
Emergency Medicine	27,867	19,101	$107.56	790
Internal Medicine	25,936	13,166	$107.35	439
Physician Assistant	24,762	10,278	$89.76	380
Neurology	9,155	5,035	$107.37	178
General Surgery	5,575	3,109	$105.96	124
Anesthesiology	4,946	2,422	$105.95	121
Cardiology	3,623	1,646	$109.43	63
Hospitalist	3,312	2,068	$105.82	100
Family Practice	2,725	1,566	$105.57	66
Nephrology	1,450	540	$105.97	20
Neurosurgery	971	402	$108.16	12
Neuropsychiatry	758	272	$103.31	4

99292 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
California	41,083	$107.95	$81.46	680
Florida	31,111	$109.50	$81.13	402
Georgia	23,316	$92.35	$72.49	284
New York	17,449	$114.03	$80.87	396
Massachusetts	14,419	$100.50	$77.55	285
Missouri	13,564	$90.46	$72.83	140
Texas	10,937	$102.96	$82.25	181
Maryland	9,976	$104.94	$79.04	216
Arizona	7,322	$101.52	$82.23	72
Illinois	7,034	$106.18	$81.38	185
New Jersey	6,883	$109.96	$82.36	121
Pennsylvania	6,351	$103.48	$81.90	164
Alabama	6,234	$86.16	$73.05	81
North Carolina	5,928	$93.70	$78.02	136
Wisconsin	4,911	$96.20	$80.86	78
Virginia	4,565	$105.13	$80.82	125
Connecticut	4,556	$103.93	$78.28	108
Kansas	3,993	$92.56	$76.84	86
Michigan	3,926	$103.27	$80.22	92
Tennessee	3,473	$92.54	$77.14	85
Colorado	3,001	$103.03	$80.79	71
Washington	2,980	$104.38	$81.83	71
Oregon	2,916	$99.09	$79.56	71
Ohio	2,667	$103.35	$82.55	78
Nevada	1,987	$101.79	$82.19	45
Kentucky	1,940	$99.08	$82.24	41
Indiana	1,741	$99.27	$82.55	54
Hawaii	1,641	$102.99	$82.73	28
Minnesota	1,617	$100.56	$82.17	44
Utah	1,481	$95.90	$76.69	34
Oklahoma	1,314	$98.38	$80.37	38
South Carolina	1,279	$98.38	$80.02	43
District of Columbia	1,221	$109.78	$81.22	31
Mississippi	1,157	$103.72	$82.79	20
Louisiana	1,095	$101.98	$81.79	33
New Hampshire	721	$98.40	$77.92	20
Iowa	661	$95.74	$80.82	18
Montana	655	$103.00	$81.32	21
Rhode Island	560	$108.22	$82.10	12
Arkansas	555	$99.43	$82.66	17
West Virginia	546	$103.11	$81.35	17
North Dakota	418	$100.09	$82.46	12
New Mexico	376	$105.19	$81.85	15
Alaska	359	$134.21	$82.11	14
Vermont	330	$100.88	$81.50	12
Nebraska	329	$100.02	$82.46	14
Delaware	319	$108.47	$82.55	6
Idaho	308	$93.07	$79.06	10
Maine	293	$102.26	$82.81	9
South Dakota	156	$98.15	$81.32	6
Wyoming	133	$107.16	$82.85	2
Guam	32	$108.44	$82.69	1
Puerto Rico	22	$105.51	$82.38	1

Related codes

99214Established patient office or other outpatient visit$117.48
99213Established patient office or other outpatient visit$83.92
99232Subsequent hospital care$76.07
99233Subsequent hospital care$115.58
99215Established patient office or other outpatient visit$163.65
99204New patient office or other outpatient visit$157.90
99223Initial hospital care$167.67
99285Emergency department visit$169.68
99203New patient office or other outpatient visit$104.03
99212Established patient office or other outpatient visit$52.42
99291Critical care$208.35
99222Initial hospital care$126.29

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.