How Much Does Critical Care (First 30-74 Minutes) Cost?
Also known as: Critical care first hour (CPT 99291)
Intensive care provided by a physician for a critically ill or injured patient requiring constant attention.
Critical Care (First 30-74 Minutes) (CPT 99291) costs $199 at Medicare rates.
The rates shown below represent the complete Medicare reimbursement for this service. No separate facility fee applies for this type of procedure.
Patient Guide: Critical Care (First 30-74 Minutes)
What you need to know before your appointment
What to Expect
A doctor provides direct bedside care including monitoring vital signs, managing life support, ordering and interpreting tests, and making rapid treatment decisions.
How Long Does It Take?
30-74 minutes of direct physician time
Common Reasons Doctors Order This
Heart attack, severe trauma, respiratory failure, sepsis, stroke, organ failure
How to Prepare
This is emergency-level care. Family members should provide medication lists and medical history to staff.
Procedures Commonly Done Together
These procedures are frequently performed alongside Critical care first hour
What Insurance Companies Actually Pay
Real negotiated rates from 15 hospitals across 6 states (from hospital price transparency filings)
| Insurance Company | Avg Rate | Range | Hospitals |
|---|---|---|---|
| Aetna | $4,351 | $710 - $15,317 | 8 |
| United | $4,581 | $724 - $14,290 | 10 |
| Cigna | $5,661 | $791 - $20,323 | 9 |
| BCBS | $4,972 | $456 - $7,960 | 5 |
| Humana | $2,159 | $717 - $4,337 | 8 |
| Multiplan | $8,171 | $1,358 - $28,580 | 6 |
| BCBS-TX | $1,619 | $973 - $2,120 | 2 |
| Kaiser | $2,520 | $1,111 - $5,318 | 2 |
| CHC | $2,845 | $534 - $3,881 | 2 |
| Anthem | $9,430 | $4,476 - $23,499 | 2 |
| Wellpoint | $817 | $534 - $1,266 | 2 |
| UNITED | $876 | $434 - $1,665 | 2 |
How to Reduce Your Cost for Critical care first hour
Practical tips that can save you hundreds or thousands of dollars
- 1 Ask about cash-pay discounts
Many hospitals and clinics offer 20-40% discounts for self-pay patients. Always ask before scheduling.
- 2 Compare facility vs. office setting costs
For this procedure, the office rate ($309) differs from the facility rate ($199). Ask if it can be done in an office setting.
- 3 Shop around — costs vary significantly
Costs can vary 2-3x between providers in the same city. Get quotes from multiple facilities.
How is the Price Calculated?
Medicare calculates procedure payments using Relative Value Units (RVUs). Each procedure has three components multiplied by a conversion factor ($33.40 in 2026) and adjusted by geographic cost indices.
Payment = Total RVU (9.25) x CF ($33.40) = $309
Related Procedures
Similar procedures in the same category or body system
Frequently Asked Questions
How much does Critical care first hour cost?
The Medicare facility rate for Critical care first hour is $199. Commercial insurance rates typically range from 150% to 250% of Medicare (varies by plan).
How much does Critical care first hour cost without insurance?
Without insurance, the cost of Critical care first hour can range from 150% of Medicare to 500% of Medicare depending on the facility. Many hospitals and clinics offer self-pay discounts of 20-40% off their chargemaster price. Always ask about cash pricing before your visit.
Does insurance cover Critical care first hour?
Most commercial health insurance plans and Medicare cover Critical care first hour when ordered by a physician for a medically necessary reason. Your out-of-pocket cost depends on your plan's deductible, copay/coinsurance structure, and whether you use an in-network provider. Check with your insurance company before scheduling to confirm coverage and get a cost estimate.
Why does the cost vary so much by location?
Medicare adjusts payments using Geographic Practice Cost Indices (GPCIs) that reflect local differences in physician work costs, practice expenses, and malpractice insurance. Manhattan, San Francisco, and other high-cost areas pay significantly more than rural regions. Commercial insurers follow similar geographic patterns.