What is the top of the local market (P90) for CPT 99291 under Bcbs Ri for New York-Newark-Jersey City, NY-NJ providers?

The P90, the top of the local market and Reddenda's target rate, is $492.61.

How does Bcbs Ri's rate for CPT 99291 compare to Medicare?

The Bcbs Ri local median of $276.10 is 89% of Medicare's national non-facility rate of $308.96 for CPT 99291.

Reddenda · Rate Intelligence · New York-Newark-Jersey City, NY-NJ

99291 under Bcbs Ri, for New York-Newark-Jersey City, NY-NJ providers

Name: Bcbs Ri rates for CPT 99291 among New York-Newark-Jersey City, NY-NJ providers
Creator: Reddenda

Critical care, first 30-74 min · Local peer median $276.10 · low

$276.10 local peer median. Bcbs Ri's published rate file lists a local peer median of $276.10 for CPT 99291 (Critical care, first 30-74 min) among 10 indexed providers in New York-Newark-Jersey City, NY-NJ. Where a Blue Cross entity’s label carries a state, that state names the file we found the rate in, not the provider’s location. Blue Cross plans file separately per state and do not share rates, even for the same provider. The top of that filed distribution, the P90 target, is $492.61, 78% above the median. A provider billed below this median is being paid less than peers holding the identical Bcbs Ri contract for the identical code. Modeled from published rates, not guaranteed.

Local distribution · 10 providers · 10 rate records

P10

$240.35

P25

$249.29

Median

$276.10

P75

$466.11

P90 (target)

$492.61

P10$240.35

P25$249.29

Median (P50)$276.10

P75$466.11

P90 target$492.61

Peer basis: local peer distribution: same CPT, same payer file, same metro (CBSA) Benchmark: local peer median; never a national average Range: $240.35 – $604.52

The local peer median for CPT 99291 under Bcbs Ri for New York-Newark-Jersey City, NY-NJ providers is $276.10, drawn from 10 distinct providers.Source: the federal Transparency in Coverage Rule (45 CFR §147.212), which compels Bcbs Ri to publish this rate
The bottom of the local market (P10) is $240.35 and the top (P90) is $492.61; the median-to-P90 spread is $216.51.Source: the federal Transparency in Coverage Rule (45 CFR §147.212), which compels Bcbs Ri to publish this rate
The lowest published rate in this market is $240.35; the highest is $604.52.Source: the federal Transparency in Coverage Rule (45 CFR §147.212), which compels Bcbs Ri to publish this rate
This benchmark is drawn from 10 individual rate records that Bcbs Ri itself published for this code in this metro.Source: the federal Transparency in Coverage Rule (45 CFR §147.212), which compels Bcbs Ri to publish this rate
Medicare's national non-facility rate for CPT 99291 is $308.96, making the Bcbs Ri local median 89% of Medicare.Source: Medicare Physician Fee Schedule; the federal Transparency in Coverage Rule (45 CFR §147.212), which compels Bcbs Ri to publish this rate
30% of indexed providers cluster at the single most common rate; the remainder shows a real, scoreable spread across the local market.Source: the federal Transparency in Coverage Rule (45 CFR §147.212), which compels Bcbs Ri to publish this rate
A federal No Surprises Act arbitrator may weigh up to four plan years of a provider's own contracted rate history and local market share when resolving a payment dispute over this exact code and payer.Source: 45 CFR §149.510(c)(4)(iii)(B)

10 providers bill this code to this payer in this metro.

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These are the rates Bcbs Ri publishes for CPT 99291 (Critical care, first 30-74 min) among New York-Newark-Jersey City, NY-NJ providers. Enter your NPI to see your own contracted rate against this peer curve, per payer and per code. Free, about 15 seconds, no card and no PHI.

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Documented reimbursement opportunity, modeled from published rates and never a guaranteed outcome.

Modeled from Bcbs Ri's own published in-network rates, never guaranteed and never a national average. Peer basis: same CPT, same payer file, same metro (CBSA). Federal citation for the underlying obligation: the federal Transparency in Coverage Rule (45 CFR §147.212), which compels Bcbs Ri to publish this rate. Page generated 2026-08-23 23:55 UTC; the live index is queried in real time on every request.