CPT 99281 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | • Evaluation and Management • Emergency Department Services |
| Common Place of Service | • 23 - Emergency Room • 11 - Office |
| Common Modifiers | • None • 25 - Significant, separately identifiable E/M service same day • 27 - Multiple outpatient E/M encounters same date |
| Complexity Level | Low |
National average reimbursement for CPT 99281 by major payers:
$23.81
$19.46
$38.04
$25.99
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 99281 | ||||||
United | 99281 | $42.88 | 1831518489 - MARISSA HAHN | 911170922 - (WA) SEATTLE EMERGENCY PHYSICIANS SERVICES, INC., P.S. | WA | Emergency Medicine Physician (207P00000X) |
United | 99281 | $22.09 | 1710349543 - AHMAD MOHAMMADIEH | 822768899 - BEAUMONT MEDICAL GROUP - HOSPITAL-BASED SERVICES | OH | Emergency Medicine Physician (207P00000X) |
United | 99281 | $26.82 | 1215354113 - MATTHEW LOWERY | 752600873 - (TX) SHANNON CLINIC | GA | Emergency Medicine Physician (207P00000X) |
United | 99281 | $52.49 | 1679518112 - MAUREEN LECLAIR-DENTLER | 200292246 - (WA) MT RAINIER EMERGENCY PHYSICIANS PLLC | WA | Emergency Medicine Physician (207P00000X) |
United | 99281 | $48.50 | 1124296132 - ADEBOLA IFAFORE | 752616977 - CHRISTUS TRINITY CLINIC | TX | Emergency Medicine Physician (207P00000X) |
United | 99281 | $48.61 | 1770585358 - JEFFREY PATEY | 340719172 - BARNESVILLE HOSPITAL ASSOCIATION INC | OH | Emergency Medicine Physician (207P00000X) |
United | 99281 | $36.40 | 1710158225 - NEIL PERERA | 821803735 - CLEVELAND CLINIC HEALTH SERVICES PROFESSIONAL ASSOCIATION INC | GA | Emergency Medicine Physician (207P00000X) |
United | 99281 | $56.29 | 1013456474 - KENNETH SHUM | 470765154 - ALEGENT CREIGHTON CLINIC | OH | Emergency Medicine Physician (207P00000X) |
United | 99281 | $28.37 | 1003079666 - SHANNA CALERO | 752668018 | TX | Emergency Medicine Physician (207P00000X) |
United | 99281 | $48.56 | 1497794531 - MARGARET HUBBARD | 911939739 - FRANCISCAN MEDICAL GROUP | WA | Emergency Medicine Physician (207P00000X) |
United | 99281 | $51.27 | 1154649259 - JOSHUA ZWART | 160743037 - (NY) HIGHLAND HOSPITAL OF ROCHESTER | WA | Emergency Medicine Physician (207P00000X) |
United | 99281 | $59.50 | 1942305941 - PARAM MAEWAL | 462598558 | TX | Emergency Medicine Physician (207P00000X) |
United | 99281 | $29.12 | 1962495994 - CHRISTOPHER JENKINS | 943484297 - (WA) WALLA WALLA GENERAL HOSPITAL | WA | Emergency Medicine Physician (207P00000X) |
United | 99281 | $33.61 | 1831500230 - HELA KOTOB | 426037892 | OH | Emergency Medicine Physician (207P00000X) |
United | 99281 | $28.43 | 1487094819 - PHILIP KRAY | 263428410 | OH | Emergency Medicine Physician (207P00000X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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CPT 99281 vs. Other Emergency Department Services Codes
The CPT 99281 code is part of the Evaluation and Management services used for Emergency Department Services. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 99281 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 99281-CPT | Low | Emergency Department Visit For The Evaluation And Management Of A Patient That May Not Require The Presence Of A Physician Or Other Qualified Health Care Professional (Desc Rvsd 1/1/23) |
| 99282-CPT | Low | Emergency Department Visit For The Evaluation And Management Of A Patient Which Requires A Medically Appropriate History And/Or Examination And Straightforward Medical Decision Making (Desc Rvsd 1/1/23) |
| 99283-CPT | Low | Emergency Department Visit For The Evaluation And Management Of A Patient Which Requires A Medically Appropriate History And/Or Examination And Low Level Of Medical Decision Making (Desc Rvsd 1/1/23) |
| 99284-CPT | Moderate | Emergency Department Visit For The Evaluation And Management Of A Patient Which Requires A Medically Appropriate History And/Or Examination And Moderate Level Of Medical Decision Making (Desc Rvsd 1/1/23) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 99281. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99281 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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