Critical Care Visits and Neonatal Intensive Care (Codes 99291 - 99292)

This transmittal corrects two errors stated in the initial transmission. The longstanding payment policy replaces language in Section H to correctly say that hospital emergency department services are not payable for the same calendar date as critical care services when provided by the same physician to the same patient. Information in Section F to calculate critical care time and the Table in Section G is corrected. It is now consistent with the coding information in the American Medical Association (AMA) Current Procedural Terminology (CPT). Additionally, medical record documentation for each physician is more clearly written in Section I and the requirement for CPT code 99291 is underlined for emphasis. The policy for staff coverage and follow-up visits is more clearly written under CPT code 99292 in Section I. Coding information for critical care to neonatal and pediatric patients in Section A is deleted pending AMA CPT changes. A grammatical clarification is made in Section C for time spent reviewing or discussing patient information which meets full attention. Clarifications are made to Section E components (off the unit/floor and split/shared service) to convey Medicare policies more clearly.

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