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See a sample rate comparisonCPT 99284 Fee Schedule
Medicare rates as of October 2026
CPT 99284 is classified under Evaluation and Management, in the Emergency Department Services subgroup.
Emergency Department Visit For, Emergency Department Visit For The Evaluation And Management Of A Patient Which Requires These 3 Key Components A Detailed History A Detailed Examination And Medical Decision Making Of Moderate Co
| Key Fact | Detail |
|---|---|
| Service Type | Evaluation and Management Emergency Department Services |
| Common Place of Service | 23 - Emergency Room 22 - On Campus Outpatient Hospital |
| Common Modifiers | 25 - Significant, separately identifiable E/M service same day U7 |
| Complexity Level | Moderate |
| Medicare Fee Schedule | $118.24 national non-facility rate (2026) · View Medicare rates for 99284 |
| Medicaid Fee Schedule | $95.56 median across 42 state programs · View Medicaid rates for 99284 |
National average reimbursement for CPT 99284 by major payers:
$154.01
BCBS / Anthem
$118.58
UnitedHealthcare
$138.72
Aetna
$181.27
Cigna
Compare published rates across providers.
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CPT 99284
5 of 25 sample ratesHigher to lower in this preview
Callee Heywood
Good Samaritan Hosptial Medical Center
$367.64Published rateJeffrey Merlin
$275.57Published rateDebra Baines
Loyola University Medical Center
$198.00Published rateScott Milinovich
$162.00Published rateChristina Eng
New York City Health And Hospitals Corporation
$86.59Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 99284 vs. Other Emergency Department Services Codes
The table lists codes related to 99284. Select one to see its fee schedule.
| Code | Complexity | Description |
|---|---|---|
| 99281-CPT | Low | Emergency Department Visit For, Emergency Department Visit For The Evaluation And Management Of A Patient Which Requires These 3 Key Components A Problem Focused History A Problemfocused Examination And Straightforward Medical |
| 99282-CPT | Low | Emergency Department Visit For, Emergency Department Visit For The Evaluation And Management Of A Patient Which Requires These 3 Key Components An Expanded Problem Focused Historyan Expanded Problem Focused Examination And Medi |
| 99283-CPT | Low | Emergency Department Visit For, Emergency Department Visit For The Evaluation And Management Of A Patient Which Requires These 3 Key Components An Expanded Problem Focused Historyan Expanded Problem Focused Examination And Medi |
| 99284-CPT | Moderate | Emergency Department Visit For, Emergency Department Visit For The Evaluation And Management Of A Patient Which Requires These 3 Key Components A Detailed History A Detailed Examination And Medical Decision Making Of Moderate Co |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 99284. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99284 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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Frequently Asked Questions
CPT stands for Current Procedural Terminology. CPT codes are five-digit numerical codes used by healthcare providers to describe medical, surgical, and diagnostic services to health insurance companies. They are crucial for accurate billing and processing of medical claims.
To find the cost of a medical procedure or service, you can typically contact your healthcare provider's billing department, review your Explanation of Benefits (EOB) from your insurance company, or use online tools. For specific price lookups based on a CPT code and your location, you can utilize tools like Payerprice.
To find specific pricing information for a medical service in your area, you can use Payerprice's fee schedule lookup tool. This tool allows you to search with a CPT code and your specific location to get relevant pricing data.
The price associated with a CPT code is often the billed charge or a fee schedule amount, but it may not be the final amount you pay. Your out-of-pocket cost can vary based on your insurance plan (deductibles, co-pays, co-insurance), whether the provider is in-network, and any discounts or financial assistance you may receive. It's always best to consult with your insurance provider and the healthcare facility for your personalized estimate.
To effectively use Payerprice's fee schedule lookup tool, you will need the specific CPT code for the medical service or procedure you are interested in and your specific location (e.g., zip code or city/state) to get localized pricing information.