CPT 99284 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 • None • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • 25 - Significant, separately identifiable E/M service same day • U7 |
| Complexity Level | Moderate |
National average reimbursement for CPT 99284 by major payers:
$154.01
$118.58
$138.72
$182.31
| 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 99284 | ||||||
United | 99284 | $166.75 | 1588045652 - JENNIFER CONNELLY | 351747218 - INDIANA UNIVERSITY HEALTH CARE ASSOCIATES INC | IN | Emergency Medicine Physician (207P00000X) |
United | 99284 | $224.55 | 1316173925 - ROBERT OLDT | 232743545 | FL | Emergency Medicine Physician (207P00000X) |
United | 99284 | $367.64 | 1932621778 - CALLEE HEYWOOD | 111888924 - GOOD SAMARITAN HOSPTIAL MEDICAL CENTER | NY | Emergency Medicine Physician (207P00000X) |
United | 99284 | $152.03 | 1699303164 - MARINA KARAMANIS | 363907436 - ROCKFORD HEALTH PHYSICIANS | IL | Emergency Medicine Physician (207P00000X) |
United | 99284 | $180.75 | 1124093257 - JAMES AIELLO | 593140335 - BAYCARE MEDICAL GROUP INC | FL | Emergency Medicine Physician (207P00000X) |
United | 99284 | $333.01 | 1568721710 - JORDAN ROGERS | 510103684 - CHRISTIANA CARE HEALTH SERVICES INC | FL | Emergency Medicine Physician (207P00000X) |
United | 99284 | $161.88 | 1043280944 - CARL METCALF | 454548708 - (IN) INTEGRATED MEDICAL SPECIALISTS, LLC DBA EMERGENCY MEDICINE OF INDIANA | IN | Emergency Medicine Physician (207P00000X) |
United | 99284 | $176.80 | 1033596689 - SALVATORE VALENTI | 760459500 - U T PHYSICIANS | TX | Emergency Medicine Physician (207P00000X) |
United | 99284 | $275.57 | 1174812085 - JEFFREY MERLIN | 760273984 | WI | Emergency Medicine Physician (207P00000X) |
United | 99284 | $210.38 | 1053706051 - EMMA SIZEMORE | 582030692 - EMORY UNIVERSITY | GA | Emergency Medicine Physician (207P00000X) |
United | 99284 | $140.22 | 1679836530 - JASON KINDRAT | 271076327 - (IN) ICEMWISHARD LLC | IN | Emergency Medicine Physician (207P00000X) |
United | 99284 | $222.97 | 1649582768 - KEI KO | 390985690 - ASPIRUS EAGLE RIVER HOSPITAL INC | TX | Emergency Medicine Physician (207P00000X) |
United | 99284 | $151.63 | 1801874698 - TODD BAKER | 431767432 - MERCY HOSPITAL LEBANON | AR | Emergency Medicine Physician (207P00000X) |
United | 99284 | $214.05 | 1508276742 - JOSHUA SLOAN | 352621082 - GRAND ISLAND REGIONAL MEDICAL CENTER | NE | Emergency Medicine Physician (207P00000X) |
United | 99284 | $202.52 | 1407815558 - TEAGUE DOMBECK | 410695603 - (MN) ST JOSEPHS AREA HEALTH SERVICES | MN | 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 99284 vs. Other Emergency Department Services Codes
The CPT 99284 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 99284 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 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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