Wiki 99291 Critical care code change

[bill2doc]

Hello,
Has anyone heard the Critical Care time will be changing in 2023 from 30-74 min for 99291 to now 35-103 min for 99291 ??

 

[natashalage]

I read about it in new 2023 guidance. I have seen a new time table for CC but cannot find it right now.

 

[wrightju1]

Someone said this at work, but I can't find any valid information on it. Does anyone have a link from a reliable source?

 

[amyjph]

The 2023 CPT book shows: 99291 first 30-74 minutes. BUT...CMS:

Critical Care Services

https://www.acep.org/federal-advocacy/federal-advocacy-overview/regs--eggs/regs--eggs-articles/regs--eggs---november-2-2022/

Despite our objections, CMS is finalizing its proposal to change the threshold for reporting CPT 99292 in addition to the base code of CPT 99291 from 75 minutes to 104 minutes. ACEP had strongly opposed this critical care policy as it differs from long-standing CPT policy, and we believe it will increase confusion among clinicians and increase administrative burden. CMS acknowledges that the policy differs from CPT policy but decided to finalize it anyway.

https://www.fortherecordmag.com/archives/Spring22p14.shtml

 

[bill2doc]

Bumping this bac u the chain. What are you all planning to do? Are you following the new CMS rule or are you following CPT policy?

 

[jkyles]

Bumping this bac u the chain. What are you all planning to do? Are you following the new CMS rule or are you following CPT policy?

Follow the CMS rule for Medicare claims and any private payer that follows CMS guidelines. Watch out for private payers because they often take a while to change policies.