What is the difference between 99291 and 99292 in IDR?

99291 covers the first block of critical care time and 99292 each added 30 minutes. In 2025, 99291 appeared in 52,132 disputes and 99292 in 1,838.

Do inpatient critical care lines pay more than ED lines?

In the 2025 files they decided higher: $1,534.00 against a $301.05 QPA for inpatient lines, and $1,077.00 against $316.49 for ED lines.

Answers / Time codes

Critical care time codes in federal IDR

Q: Which companion lines appear most often with critical care?

Blood counts (85025) appeared in 4,072 disputes, the highest ED visit level (99285) in 3,371, and metabolic panels (80053) in 2,876.

Under the No Surprises Act, critical care is billed by time: 99291 for the first block and 99292 for each added 30 minutes. In the 2025 files, 99291 lines had a median QPA of $315.23 and a median decided award of $1,077.10, and 99292 lines a $232.95 QPA and a $2,400 award. Provider wins on the two codes add up to $135.3 million in prevailing offers.

Two codes for one stretch of care

The first block of critical care time is billed as 99291, and each added 30 minutes as 99292. The files show 99291 in 52,132 of the 52,569 disputes and 99292 in 1,838, which is 3.5 percent of the total. Disputes average 1.5 lines each, so many carry more than one line. Both codes are billed by time, and patient acuity and the complexity of the service are among the factors an arbitrator may weigh beyond the QPA.

What each setting pays

Setting changes the picture. Among 59,038 emergency department 99291 lines that report a QPA and offers, the median QPA was $316.49 and the median decided award $1,077.00, or 3.40 times the QPA. Among 5,053 inpatient lines the median QPA was lower, $301.05, and the median award higher, $1,534.00, or 5.10 times. The add-on code decided furthest above its benchmark: $2,400 against $232.95, or 10.30 times, across 1,117 lines. Provider wins on 99291 came to $131.8 million in 2025 and on 99292 to $3.5 million.

Lines that travel with critical care

Critical care disputes often carry other lines from the same encounter. Blood counts (85025) appear in 4,072 disputes, the highest ED visit level (99285) in 3,371, metabolic panels (80053) in 2,876, IV push administration (96375) in 2,494, and EKG tracings (93005) in 2,293. Providers won between 80.07 and 84.89 percent of the disputes that carried each of them, against 88.08 percent for disputes carrying 99291.

Setting the offer

Decided awards sit well above the QPA, so the offer should start from decided results for the same code, setting, and payer. Medians are a guide, not a forecast: the 99292 figure rests on 1,117 lines, and the gap between ED and inpatient lines may reflect which groups file where. Lido IDR builds each offer from decided lines at idrexplorer.com and files for a flat fee per arbitration.

Build the offer from decided results

Lido IDR sets 99291 and 99292 offers from decided lines in the same setting, then files for a flat fee per arbitration. Talk to an IDR specialist.