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See a sample rate comparisonCPT 99285 Fee Schedule
Last Verified: October 2026
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.
Emergency Department Visit For, Emergency Department Visit For The Evaluation And Management Of A Patient Which Requires These 3 Key Components Within The Constraints Imposed By Theurgency Of The Patients Clinical Condition Ando
| Key Fact | Detail |
|---|---|
| Service Type | Evaluation and Management Emergency Department Services |
| Common Place of Service | 23 - Emergency Room 21 - Inpatient Hospital |
| Common Modifiers | 25 - Significant, separately identifiable E/M service same day GC - Service performed by resident under supervision |
| Complexity Level | High |
| Medicare Fee Schedule | $171.35 national non-facility rate (2026) · View Medicare rates for 99285 |
| Medicaid Fee Schedule | $138.99 median across 42 state programs · View Medicaid rates for 99285 |
National average reimbursement for CPT 99285 by major payers:
$223.70
$169.52
$194.95
$266.96
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CPT 99285
5 of 25 sample ratesHigher to lower in this preview
Medical Center Emergency Physicians PA
Medical Center Emergency Physicians P.A.
$614.03Published rateMark Binkley
$354.82Published rateOchsner Clinic LLC
$274.35Published rateNicole Seleno
Chelsea Community Hospital
$200.67Published rateSamantha Booker
$125.79Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 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, 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 |
| 99285-CPT | High | Emergency Department Visit For, Emergency Department Visit For The Evaluation And Management Of A Patient Which Requires These 3 Key Components Within The Constraints Imposed By Theurgency Of The Patients Clinical Condition Ando |
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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Frequently Asked Questions
CPT 99285 is an Evaluation and Management service code specifically for Emergency Department Services, indicating a moderate-complexity encounter. It stands apart from lower-level codes due to requiring more provider time and moderate medical decision-making, in contrast to codes for simpler assessments. Encounters typically coded with 99285 often involve multiple diagnoses, management of medications, or interpretation of tests. This results in higher reimbursement and necessitates more extensive documentation. For specific fee schedule information related to CPT 99285 or other codes in your location, you can utilize Payerprice's fee schedule lookup tool.