CPT
90471 — Immunization administration, single vaccine
ACA-covered vaccines should be free, including the admin fee.
Critical care
99291 — Critical care, first 30–74 minutes
The first 30 to 74 minutes of critical care services for a critically ill or injured patient. Time-based — every minute must be documented.
- Typical setting: ICU, ED, trauma bay, or any critical care setting
- National avg charge (illustrative): Insurance allowed $215–$320.
- Most-disputed reason: Patient wasn't critically ill, or time wasn't documented.
What it means
What 99291 actually means
CPT 99291 reports the first 30 to 74 minutes of critical care provided to a critically ill or critically injured patient. 'Critical care' has a specific meaning: there must be a high probability of imminent or life-threatening deterioration, and the physician must be providing direct, focused care.
Critical care is NOT the same as 'in the ICU.' A stable patient being monitored in the ICU is billed under subsequent hospital care codes (99231–99233), not critical care. The physician must be performing high-complexity decision-making during the time billed.
Common errors with this code
What goes wrong on real bills.
Most bills that look correct still contain at least one of these issues. Up to 49% of medical bills contain errors (CFPB).
- Billed for stable ICU patients who don't meet the 'critically ill' definition.
- Time inflated — physician was at the bedside 20 minutes but billed 99291 for 35.
- Billed alongside the same physician's subsequent hospital care code on the same day for the same patient.
- Billed concurrent with a same-day E/M code that should have been bundled.
If you see 99291 on your bill
Three steps before paying.
1. Get the itemized bill. If your statement only shows a summary, request the CPT-level itemized bill before paying. Generate the request language →
2. Cross-check against the EOB. Compare what your insurer's Explanation of Benefits says you owe versus what the hospital is asking. They disagree more often than people think. Read the bill-vs-EOB guide →
3. Run a free Bill Scan. Upload the bill (and EOB if you have it) and BillBusted will flag the most likely issues with this specific code in your specific state. Run free scan →
Related codes
Other codes in this category.
People who land on 99291 often also see these adjacent codes on the same bill.
CPT
90472 — Immunization admin; each additional vaccine
Vaccine — admin (90471) is separate from the vaccine product code.
CPT
90651 — Human papillomavirus vaccine types 6, 11, 16, 18, 31, 33, 45, 52, 58, nonavalent , IM
Vaccine — admin (90471) is separate from the vaccine product code.
CPT
90670 — Pneumococcal conjugate vaccine, 13 valent , IM
Vaccine — admin (90471) is separate from the vaccine product code.
CPT
90671 — Pneumococcal conjugate vaccine, 15 valent , IM
Vaccine — admin (90471) is separate from the vaccine product code.
CPT
90677 — Pneumococcal conjugate vaccine, 20 valent , IM
Vaccine — admin (90471) is separate from the vaccine product code.
Related BillBusted guides
Plain-English reads if you see 99291 on a bill.
99291 FAQ
Plain-English answers.
What makes a patient 'critical' for this code?
Per AMA CPT, the patient must have a critical illness or injury that acutely impairs one or more vital organ systems with a high probability of imminent or life-threatening deterioration. Examples: respiratory failure requiring vent management, refractory shock, status epilepticus, acute MI with active intervention. Routine post-op recovery in the ICU usually doesn't qualify.
How is the time documented?
The physician must document specific minutes spent on critical care activities (excluding procedures billed separately). 'Critical care: 45 minutes' is the bare minimum; better notes specify what was done during those minutes (review, exam, family discussion, decision-making).
Don't pay 99291 blindly.
The free scan tells you in under 60 seconds whether this charge looks reasonable for your situation.