Emergency department & critical care

99291 - RVUs & Medicare payment (2026)

Critical care, first 30-74 minutes.

Component	Non-facility	Facility
Work RVU	4.50	4.50
Practice expense RVU	4.29	1.00
Malpractice RVU	0.46	0.46
Total RVUs	9.25	5.96
National payment (CF $33.4009)	$308.96	$199.07
Qualifying APM payment (CF $33.5675)	$310.50	$200.06

How 99291 payment varies by locality

Medicare adjusts payment with geographic practice cost indices, so the same code pays differently across the 109 fee schedule localities. In 2026, non-facility payment for 99291 ranges from $281.30 in Arkansas (AR) to $386.53 in Alaska (AK); calculate 99291 for your locality.

Alaska (AK) $386.53 San Jose-Sunnyvale-Santa Clara (CA) $381.70 San Jose-Sunnyvale-Santa Clara (CA) $379.56 San Francisco-Oakland-Berkeley (CA) $373.67 San Francisco-Oakland-Berkeley (CA) $373.15 NYC Suburbs/Long Island (NY) $358.83 Napa (CA) $356.43 Vallejo (CA) $355.68 National average $308.96 … 97 more localities between … Iowa (IA) $287.51 Mississippi (MS) $285.03 Alabama (AL) $284.38 Arkansas (AR) $281.30

Non-facility payment for 99291 in the 2026 fee schedule ($33.4009 conversion factor), before sequestration. Gray bar = national average.

Global period: XXX

No global period: the global surgery concept does not apply to this code.

Related codes - emergency department & critical care

99281 · emergency department visit, level 1
99282 · emergency department visit, level 2
99283 · emergency department visit, level 3
99284 · emergency department visit, level 4
99285 · emergency department visit, level 5
99292 · critical care, each additional 30 minutes

Frequently asked questions

How much does Medicare pay for 99291 in 2026?

The national non-facility payment is $308.96 and the facility payment is $199.07, using the standard $33.4009 conversion factor. Actual amounts vary by Medicare locality; use the RVU calculator for your area.

What is the work RVU for 99291?

The 2026 work RVU for 99291 is 4.50. Total RVUs are 9.25 in the non-facility setting and 5.96 in the facility setting.

Why are the facility and non-facility amounts different?

Only the practice expense component changes by setting. In an office (non-facility) the practice bears the overhead, so the PE RVU is higher; in a hospital or ASC the facility bills its own overhead separately.

Source: CMS Physician Fee Schedule relative value file (rvu26c.zip, retrieved 2026-07-11). Service description is an original plain-English summary, not CPT descriptor text. CPT® is a registered trademark of the American Medical Association. Amounts are estimates before sequestration and claim-level adjustments.