E/M Weekly Tip: CPT Modifier 25 (Critical Care)

Services, such as endotracheal intubation (CPT code 31500) and the insertion and placement of a flow directed catheter, e.g., Swan-Ganz (CPT code 93503), are not bundled into the critical care codes.

Separate payment may be made for critical care in addition to these services if the critical care was a significant, separately identifiable service and it was reported with CPT modifier 25. The time spent performing the pre, intra and post procedure work of these unbundled services, e.g., endotracheal intubation, shall be excluded from the determination of the time spent providing critical care.
This policy applies to any procedure with a 0, 10 or 90 day global period, including cardiopulmonary resuscitation (CPT code 92950). CPR has a global period of 0 days and is not bundled into critical care codes.

Therefore, critical care may be billed in addition to CPR if critical care was a significant, separately identifiable service and it was reported with CPT modifier 25. The time spent performing CPR shall be excluded from the determination of the time spent providing critical care. In this instance, it must be the physician who performs the resuscitation who bills for this service. Members of a code team must not each bill Medicare Part B for this service.

For more information, please visit the Medicare Claims Processing Manual, 100-04, Chapter 12, Section 30.6.12. K at CMS website (PDF, 1.3 MB).