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 | $200.50 | 1336388164 - ARTURO SORIA | 820380784 - KOOTENAI HEALTH INC | CA | Emergency Medicine Physician (207P00000X) |
United | 99285 | $437.79 | 1497374763 - LYNEA BULL | 581537752 - EMORY UNIVERSITY | GA | Emergency Medicine Physician (207P00000X) |
United | 99285 | $353.60 | 1740218122 - KYRAN COLBRY | 431960221 - (OR) SALEM HEALTH WEST VALLEY | OR | Emergency Medicine Physician (207P00000X) |
United | 99285 | $281.19 | 1073719100 - ANDREW THOMPSON | 141996067 | SC | Emergency Medicine Physician (207P00000X) |
United | 99285 | $385.29 | 1780900043 - STEVEN LINDSEY | 581537752 - EMORY UNIVERSITY | GA | Emergency Medicine Physician (207P00000X) |
United | 99285 | $233.05 | 1750598462 - LUCAS COUNTY HEALTH CENTER, LCHC ER GROUP | 426039708 - LUCAS COUNTY HEALTH CENTER | IA | Emergency Medicine Physician (207P00000X) |
United | 99285 | $434.60 | 1245200674 - GORDON APPELBAUM | 330106028 - (CA) SHARP REES-STEALY MEDICAL GROUP, INC. | CA | Emergency Medicine Physician (207P00000X) |
United | 99285 | $256.98 | 1033593629 - YEVHENIY LIDER | 440552485 - MERCY HOSPITAL SPRINGFIELD | GA | Emergency Medicine Physician (207P00000X) |
United | 99285 | $197.50 | 1164461752 - DAVID FRIEND | 680357690 - ADVENTIST HEALTH PHYSICANS NETWORK | CA | Emergency Medicine Physician (207P00000X) |
United | 99285 | $312.60 | 1447836846 - MICHAEL WAKELY | 390816848 - MERCY HEALTH SYSTEM CORPORATION | WI | Emergency Medicine Physician (207P00000X) |
United | 99285 | $353.60 | 1609308634 - ANTHONY CHO | 742931198 - (TX) THIRD COAST EMERGENCY PHYSICIANS SOUTHWEST PA | TX | Emergency Medicine Physician (207P00000X) |
United | 99285 | $376.20 | 1528554391 - AGNIESZKA GAERTIG | 204700877 | FL | Emergency Medicine Physician (207P00000X) |
United | 99285 | $150.61 | 1972640472 - NELSON JAEGGLI | 472334194 - (TX) COMMUNITYMED PCP | TX | Emergency Medicine Physician (207P00000X) |
United | 99285 | $304.73 | 1669892618 - MICHAEL CARR | 582030692 - EMORY UNIVERSITY | GA | Emergency Medicine Physician (207P00000X) |
United | 99285 | $263.50 | 1043707045 - DANIELA ORTIZ | 300791563 | 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 | 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 | 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 | 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 | 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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