Cardiopulmonary Resuscitation (CPR) FAQ

CPR is performed when the patient’s heart and lungs suddenly stop. CPR involves the provision of cardiac life support, including chest compressions, ventilation and emergency cardiac defibrillation of the patient. CPT states 92950 is intended to describe CPR to restore and maintain the patient’s respiration and circulation after cessation of heartbeat and breathing. Basic CPR consists of assessing the victim, opening the airway, restoring breathing (e.g., mouth-to-mouth, bag-valve-mask, etc.), and restoring circulation (e.g., closed chest cardiac massage).

The physician does not have to physically perform the chest compressions or ventilation of the patient, but rather can direct the provision of CPR services. According to the AMA, “From a coding perspective, indeed the physician may report 92950 whether he/she is actually performing compressions or ventilation or directing these activities while other staff is actually performing cardiopulmonary resuscitation.” However, only one physician may report an episode of CPR, regardless of the participation of other physicians in the resuscitative process.

ACLS involves the provision of drug therapy and possibly emergency cardiac defibrillation. These services are reported with the appropriate E/M service, such as 9928X or critical care (99291). CPT states, “In most instances, CPR is performed prior to, with continuation during, advanced life support interventions, e.g., drug therapy and emergency cardiac defibrillation, which would be included by reporting the appropriate critical care services code(s) from the E/M section of the CPT codebook.”

ACLS does not always require CPR or emergency cardiac defibrillation. CPR requires some form of chest compressions and sometimes ventilation that are not a direct component of ACLS. CPR can include emergency cardiac defibrillation; however, emergency cardiac defibrillation in the absence of CPR is not a separately billable procedure. In these cases, E/M services, such as 9928X or critical care (99291), would be appropriate.

No. CPT lists no minimum or maximum amount of time spent performing and/or supervising CPR as being required to report CPR.

Yes, as long as the respective requirements for each service are satisfied and evident from the medical record. Both CPT and Medicare agree on this point.

CPR is a non-E/M service encompassing such activities as supervising or performing chest compressions, adequate ventilation of the patient (e.g., bag-valve-mask), etc. CPT does not list a typical time to qualify for providing CPR. As a separately reportable service with Critical Care, the time spent providing CPR cannot be counted toward calculating total Critical Care time.

See ACEP Critical Care FAQ for further details. 

According to the AMA, “Cardiopulmonary resuscitation” was deleted as an inclusive service of the Critical Care services codes at the June 1992 CPT Editorial Panel meeting for CPT 1993. Therefore, since January 1, 1993, it has, and currently remains, appropriate for the physician to report CPR (code 92950) in addition to the Critical Care Service code(s).

Following an episode of CPR, if a patient regains vital signs, and care meeting the definition of Critical Care was provided for at least 30 minutes, then it would be appropriate to report CPR and Critical Care services. Similarly, if a patient were to receive Critical Care services and then subsequently require CPR, it would be appropriate to report both services. However, if the patient received Critical Care for less than 30 minutes outside of the CPR time, then CPR and an E/M level such as 9928X should be reported.  

If the patient encounter does not satisfy Critical Care requirements, the E/M level of service (e.g., 9928X) should be determined by the extent of the medical decision-making performed (See ACEP FAQ 2023 E&M Guideline). The E/M level should be proportional to the amount of work performed when determining the medical decision-making while CPR is being performed. 

Yes. The emergency physician must document a procedure note, just like he/she would with any other procedure. It is also possible to report CPR together with a subsequent hospital visit or critical care if the respective E/M performance, time, and documentation requirements are met. (See Floor Emergency FAQs)

There are no specifically defined documentation criteria for reporting CPR listed in CPT. Providers should be aware of the need to demonstrate medical necessity and the services provided. A procedure note stating that CPR was performed may be part of a hospital wide uniform “code sheet.”

Yes. Other procedures such as intubations, central lines, etc. can be reported in addition to CPR.  

In some circumstances and/or for some payers, practitioners may need to indicate that a given episode of CPR and other services are in fact mutually separate and distinct. In such instances, the -25 modifier (appended to E/M services) is usually utilized to distinguish a non-E/M service from E/M services (e.g., Critical Care, ED E/M, etc.) and the -59 modifier is utilized to distinguish one non-E/M service from other non-E/M services (e.g., Intubation, endotracheal, emergency procedure; etc.).

Yes, a patient may have an episode of CPR performed and concluded with a return of spontaneous circulation. If the patient’s condition later deteriorates and a subsequent episode of CPR is required, it can be reported again with clear documentation that it is a distinct and separate episode from the preceding CPR procedure.

Multiple units of 92950 would not be reported for stopping and restarting compressions during the same resuscitation episode.  The medical record should clearly demonstrate that the patient recovered from the initial episode of CPR and distinct and separate CPR procedure was later necessary due to a change in the patient’s condition. 

CMS/NCCI indicates an MUE of 2 for CPT code 92950. Medically Unlikely Edits (MUE) are limits for repeat procedures rendered by a single provider to a patient on a calendar day. When the MUE limit is exceeded, the payers’ automated claims processing system will likely require supporting documentation before processing the claim.