Does emergency department critical care count as an emergency service?

Yes. Care in a hospital emergency department or an independent freestanding emergency department is an emergency service under the No Surprises Act, including the critical care needed to stabilize the patient.

Are intensivists protected when the hospital is in network?

Yes. The regulations list intensivist services among the ancillary services at a participating facility, so a patient cannot be asked to waive balance billing protection for them.

Which critical care claims fall outside federal IDR?

Medicare, Medicare Advantage, Medicaid, and TRICARE claims are outside it, and in a state that has set up its own surprise billing process, a fully insured plan follows that process instead.

Answers / Who qualifies

Can critical care physicians use federal IDR?

Yes, in most settings. Under the No Surprises Act, critical care furnished in an emergency department is an emergency service, and intensivist services at a participating hospital are on the list of services patients can never be asked to waive. In the 2025 files, 93.48 percent of disputes with a 99291 line came from the ED and 5.98 percent from inpatient units.

Critical care in the emergency department

Emergency services under the Act cover the screening exam and the care needed to stabilize a patient, at a hospital emergency department or an independent freestanding one. They are protected whether or not the facility or the physician is in network, and a patient cannot be asked to waive that protection. Critical care time in the ED is part of that stabilizing care. It is also where nearly all of this code family sits: 48,731 of the 52,132 disputes with a 99291 line in 2025 carried the ED place-of-service code, and 1,413 of the 1,838 disputes with a 99292 line did.

Critical care in the ICU

Three situations come up. At a participating hospital, the regulations list intensivist services among the ancillary services, so an out-of-network intensivist cannot balance bill and a patient cannot sign that protection away. After emergency care, an admission to the ICU is post-stabilization care, which stays protected unless a strict set of conditions for consent is met, among them that the patient can travel by nonmedical transport and is able to consent. A patient who needs ICU-level care rarely meets them. A planned ICU stay at an out-of-network hospital is outside the Act. Inpatient units produced 3,119 of the 2025 disputes with a 99291 line, and those lines decided at a median of $1,534.00 against a $301.05 QPA.

What falls outside federal IDR

Medicare, Medicare Advantage, Medicaid, and TRICARE claims are outside it. In a state that has set up its own surprise billing process, a fully insured plan follows that process instead. The plan type in the files shows how much of the volume is federal in practice: 37,341 of the 52,569 disputes in 2025 came from self-insured employer plans (71.0 percent), 6,967 from fully insured group plans, and 2,278 from individual-market plans. Timing matters too. The open negotiation period lasts 30 business days from the initial payment or denial, and the request for IDR must follow within 4 business days after it ends.

Checks to run before filing

Four facts decide most critical care claims: the plan type and whether a state process applies, the place of service on the claim (ED or inpatient), whether the hospital participates in the plan's network, and the date of the initial payment or denial. Groups that sort claims on those four before filing keep out-of-scope lines out of the queue. Lido IDR runs those checks and tracks both deadlines, then files for a flat fee per arbitration, with offers priced from the published decisions at idrexplorer.com.

Check each claim before it files

Lido IDR sorts critical care claims by setting and plan type, tracks the open negotiation and filing deadlines, and files for a flat fee per arbitration. Talk to an IDR specialist.