Critical care first hour
Critical care evaluation and management for the first hour shows hospital outpatient charges 4.2x the Medicare rate of $200.06, making bill verification essential given this $642 potential difference.
About the analyst
Elena Vasquez leads hospital billing pattern analysis at BillRazor Research. She focuses on identifying overcharges, markup outliers, and patient advocacy strategies. Expertise: hospital billing patterns, overcharge analysis, patient advocacy.
This procedure covers the first hour of critical care management for patients in life-threatening conditions requiring constant physician attention, typically in ICUs or emergency departments. Patients include those with severe respiratory failure, cardiac arrest, or multi-organ dysfunction. The Medicare benchmark is $957, though facility charges can reach 14.0x the Medicare reimbursement depending on the hospital setting.
No credit card required. Results in 60 seconds.
Facility rate
$200
National Medicare benchmark
Non-facility rate
$99
Office setting benchmark
Data sources
3
23 data points
Key insights for CPT 99291
Facility vs office setting
$101 differenceNon-facility setting is less expensive for this procedure
What this procedure costs across different settings
The same procedure can cost very different amounts depending on where it's performed. These are the Medicare-allowed amounts — what hospitals actually charge can be 3-10x higher.
| Setting | Medicare rate | vs lowest |
|---|---|---|
| Facility (physician office) | $200 | +102% |
| Non-facility (office) | $99 | Lowest |
| Outpatient (APC) | $843 | +751% |
Got a bill with CPT 99291?
Upload your bill and our AI compares every line item against these exact benchmark rates. Free analysis in 60 seconds — you only pay if we find savings.
About this data
Rates shown are from the 2026 Medicare Physician Fee Schedule, Hospital Outpatient Prospective Payment System (OPPS), Ambulatory Surgery Center Payment System, Clinical Laboratory Fee Schedule, Durable Medical Equipment Fee Schedule, and CMS Inpatient Prospective Payment System (DRG weights). Regional adjustments use CMS Geographic Practice Cost Indices (GPCI). Hospital charges are from CMS Hospital Price Transparency machine-readable files. All data is publicly available under federal law (45 CFR Part 180).
This data is for informational purposes only and does not constitute medical or financial advice. Actual costs depend on insurance coverage, negotiated rates, and individual circumstances.
Related procedures
Related pricing data
Data: Medicare Physician Fee Schedule, CMS Inpatient PPS (IPPS), Outpatient PPS (OPPS), ASC Payment System, Clinical Lab Fee Schedule (CLFS), National Average Drug Acquisition Cost (NADAC). FY 2024 data. All publicly available from CMS.
Methodology: Facility rate applies when the procedure is performed in a hospital or ASC. Non-facility rate applies in a physician office. GPCI adjustments reflect regional cost-of-living differences.
This information is for educational purposes only and is not medical, financial, or legal advice. Actual costs depend on your insurance and provider. We recommend verifying costs directly with your provider. Full methodology · Terms of use