Medicare_Carriers_Manual / 15508 / 15508

Why This Topic Matters

The guidance helps providers and coders distinguish critical care from other evaluation and management services, recognize bundled procedures, and document claims appropriately in settings where Medicare payment rules are specific and time-sensitive.

Article Sections

1. Ed. Note: For further information see

   References to related manual chapters and topical guidance areas that provide additional background on critical care and prolonged services.

2. 15508. Critical Care Visits and Neonatal Intensive Care

   Overview of Medicare carrier policy for critical care visits, including service context, timing, and related billing considerations.

3. A. Use of Critical Care (Codes 99291 and 99292) in Cases Which Are Not Medical Emergencies

   General policy discussion of critical care in non-emergency settings and the types of patients and environments addressed.

4. B. Constant Attendance or Constant Attention as Prerequisite for Use of Critical Care Codes

   Policy language on physician availability, where work time may be counted, and documentation of time and service activity.

5. C. Hours and Days of Critical Care That May Be Billed By

   Guidance on billing frequency and review considerations for unusually large amounts of critical care on the same date.

6. D. Critical Care Visits and Other Procedures Provided on Same Day By Same Physician As Critical Care Codes 99291 and 99292

   Discussion of same-day procedure bundling, separate payment considerations, and related evaluation and management and interpretation issues.

7. E. Counting of Units of Critical Care Services

   Instructions on unit counting for critical care reporting and examples of total-duration groupings.

8. F. Critical Care Service and other Evaluation and Management Services Provided on Same Day

   Policy on reporting critical care alongside other evaluation and management services on the same day and associated documentation.

9. G. Critical Care Services Provided During Pre-Operative Portion of Global Period of Procedure With 90 Day Global Period in Trauma and Burn Cases

   Special documentation and reporting considerations for pre-operative critical care in trauma and burn cases within a global surgical period.

10. H. Critical Care Services Provided During Post-Operative Period of Procedure With Global Period in Trauma and Burn Cases

    Special documentation and reporting considerations for post-operative critical care in trauma and burn cases within a global surgical period.