CPT 99285 Medicare Fee Schedule 2026
Medicare's 2026 national payment for CPT 99285 is $171.35 in a non-facility setting ($171.35 in a facility), up 1.5% from $168.85 in 2025.
- Non-facility
- $171.35
- Facility
- $171.35
- vs. 2025
- +1.5%
- Commercial national avg.
- $213.78
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Run a free sample reportEmergency Department Visit For, Emergency Department Visit For The Evaluation And Management Of A Patient Which Requires These 3 Key Components Within The Constraints Imposed By Theurgency Of The Patients Clinical Condition Ando
| Code | Date | State | Locality | Carrier | Non-Facility Fee | Facility Fee | Description |
|---|---|---|---|---|---|---|---|
| 99285 | 10/2026 | N/A | 00 | 00000 | $171.35 | $171.35 | Emergency Department Visit For, Emergency Department Visit For The Evaluation And Management Of A Patient Which Requires These 3 Key Components Within The Constraints Imposed By Theurgency Of The Patients Clinical Condition Ando |
| 99285 | 7/2026 | N/A | 00 | 00000 | $171.35 | $171.35 | Emergency Department Visit For, Emergency Department Visit For The Evaluation And Management Of A Patient Which Requires These 3 Key Components Within The Constraints Imposed By Theurgency Of The Patients Clinical Condition Ando |
| 99285 | 4/2026 | N/A | 00 | 00000 | $171.35 | $171.35 | Emergency Department Visit For, Emergency Department Visit For The Evaluation And Management Of A Patient Which Requires These 3 Key Components Within The Constraints Imposed By Theurgency Of The Patients Clinical Condition Ando |
| 99285 | 1/2026 | N/A | 00 | 00000 | $171.35 | $171.35 | Emergency Department Visit For, Emergency Department Visit For The Evaluation And Management Of A Patient Which Requires These 3 Key Components Within The Constraints Imposed By Theurgency Of The Patients Clinical Condition Ando |
| 99285 | 10/2025 | N/A | 00 | 00000 | $168.85 | $168.85 | Emergency Department Visit For, Emergency Department Visit For The Evaluation And Management Of A Patient Which Requires These 3 Key Components Within The Constraints Imposed By Theurgency Of The Patients Clinical Condition Ando |
| 99285 | 7/2025 | N/A | 00 | 00000 | $168.85 | $168.85 | Emergency Department Visit For, Emergency Department Visit For The Evaluation And Management Of A Patient Which Requires These 3 Key Components Within The Constraints Imposed By Theurgency Of The Patients Clinical Condition Ando |
| 99285 | 4/2025 | N/A | 00 | 00000 | $168.85 | $168.85 | Emergency Department Visit For, Emergency Department Visit For The Evaluation And Management Of A Patient Which Requires These 3 Key Components Within The Constraints Imposed By Theurgency Of The Patients Clinical Condition Ando |
| 99285 | 1/2025 | N/A | 00 | 00000 | $168.85 | $168.85 | Emergency Department Visit For, Emergency Department Visit For The Evaluation And Management Of A Patient Which Requires These 3 Key Components Within The Constraints Imposed By Theurgency Of The Patients Clinical Condition Ando |
99285 national rate by year
Each row is the latest CMS file published that year. Change is against the year before.
| CMS file | Non-facility | Facility | Change |
|---|---|---|---|
| October 2026 | $171.35 | $171.35 | +1.5% |
| October 2025 | $168.85 | $168.85 | -2.5% |
| March 2024 | $173.10 | $173.10 | -2.0% |
| January 2023 | $176.55 | $176.55 | -1.3% |
| July 2022 | $178.91 | $178.91 | - |
This is the national amount before geographic adjustment. Medicare multiplies each relative value unit by its locality's geographic practice cost index, so a practice's own allowed amount can be higher or lower; pick a state above to see its localities. The facility amount applies when the service is performed in a hospital or other facility setting.
99285: Medicare vs. commercial national average
The commercial national average for 99285, the mean of what BCBS, UnitedHealthcare, Aetna and Cigna publish nationwide, is $213.78, 125% of Medicare's $171.35.
- BCBS $223.70
- UnitedHealthcare $169.52
- Aetna $194.95
- Cigna $266.96
A national average, not a local rate: each payer's figure averages the unmodified, in-network professional rates it publishes for 99285 across the country in its transparency files. Contracted rates vary widely by market, provider and plan. Medicare's figure is its national non-facility amount before geographic adjustment.
Nearby codes
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State Medicaid programs pay a median of $138.99 for 99285
Across 42 state fee schedules the rate runs from $62.87 in WI to $323.58 in AK - a 5.1x spread. That median is 81% of Medicare's $171.347 national non-facility rate. Free to explore state by state.
17,674 codes and 974,327 published rates, taken from the files the state agencies publish themselves.
Related codes
Methodology
Rates are sourced directly from CMS Physician Fee Schedule files, indexed quarterly. Non-facility and facility prices are calculated using the published GPCI for each locality and the year's conversion factor.
View CMS Physician Fee Schedule