CPT 99285 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address high-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 • 21 - Inpatient Hospital |
| Common Modifiers | • None • 25 - Significant, separately identifiable E/M service same day • GC - Service performed by resident under supervision |
| Complexity Level | High |
National average reimbursement for CPT 99285 by major payers:
$223.70
$169.52
$194.95
$266.96
| 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 99285 | ||||||
United | 99285 | $320.76 | 1558523753 - JONATHAN RATCLIFF | 581537752 - EMORY UNIVERSITY | GA | Emergency Medicine Physician (207P00000X) |
United | 99285 | $147.30 | 1295174761 - SEAN NARDI | 952801772 - (CA) CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO INC | CA | Emergency Medicine Physician (207P00000X) |
United | 99285 | $437.79 | 1043496979 - GEORGE LEACH | 582030692 - EMORY UNIVERSITY | GA | Emergency Medicine Physician (207P00000X) |
United | 99285 | $125.79 | 1417474776 - SAMANTHA BOOKER | 853195113 | AL | Multi-Specialty Group (193200000X) |
United | 99285 | $278.63 | 1063856979 - RYAN FREEDMAN | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | Emergency Medicine Physician (207P00000X) |
United | 99285 | $177.08 | 1417956467 - ABAYOMI OSHINOWO | 920443731 | AL | Emergency Medicine Physician (207P00000X) |
United | 99285 | $440.10 | 1295262558 - IKECHUKWU AMOBI | 352574944 - (AZ) SOUND PHYSICIANS EMERGENCY MEDICINE OF ARIZONA INC | CA | Emergency Medicine Physician (207P00000X) |
United | 99285 | $165.00 | 1043835812 - KENYA MARSH | 630917523 | AL | Multi-Specialty Group (193200000X) |
United | 99285 | $264.44 | 1073834123 - VALERIE GIRONDA | 237441353 - MONONGALIA COUNTY GENERAL HOSPITAL COMPANY | GA | Emergency Medicine Physician (207P00000X) |
United | 99285 | $376.20 | 1528554391 - AGNIESZKA GAERTIG | 204700877 | FL | Emergency Medicine Physician (207P00000X) |
United | 99285 | $263.50 | 1669097382 - STAR ED PLLC | 851199989 - (TX) STAR ED PLLC | TX | Multi-Specialty Group (193200000X) |
United | 99285 | $307.50 | 1427287424 - NEIL CHRISTOPHER | 113465690 | NY | Emergency Medicine Physician (207P00000X) |
United | 99285 | $282.61 | 1710143722 - OCHSNER CLINIC LLC, OCHSNER HEART AND VASCULAR INSTITUTE HAMMOND | 720276883 | LA | Multi-Specialty Group (193200000X) |
United | 99285 | $213.39 | 1619956976 - JOHN FOSBINDER | 956005450 - (CA) SOUTHERN INYO HEALTHCARE DISTRICT | CA | Emergency Medicine Physician (207P00000X) |
United | 99285 | $327.76 | 1487001962 - KEVIN OLIVER | 460224598 - AVERA ST LUKES | TX | 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 99285 vs. Other Emergency Department Services Codes
The CPT 99285 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 99285 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) |
| 99285-CPT | High | Emergency Department Visit For The Evaluation And Management Of A Patient Which Requires A Medically Appropriate History And/Or Examination And High 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 99285. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99285 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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