CPT code 99281: ED visit, may not require physician presence2026 Medicare rate & RVUs

Medicare pays $11.02 for 99281 nationally in a facility.

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

What 99281 covers

99281 is the lowest-level emergency department evaluation and management service. It covers an ED encounter whose care may not require a physician or other qualified health care professional to be physically present. It is specific to the emergency department setting; an office visit or an inpatient hospital service is not reported with this code. Triage by itself does not establish that an ED evaluation and management service was furnished.

Document the reason for the visit, the assessment or care provided, and why the encounter supports this level rather than a higher ED service. Unlike 99282–99285, 99281 is not distinguished by a stated medical decision-making level in its descriptor. On a Medicare physician claim, it is valued under the Physician Fee Schedule as a professional service; the hospital reports its facility services through the applicable facility payment system.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

Where 99281 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

99281 rates by state

Office rate range in each state. Select a state to see its payment localities.

How the 99281 rate is calculated

Each of 99281’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

Payment rules and modifiers for 99281

99281 has no global surgery period, no multiple-procedure, bilateral or assistant-at-surgery adjustment, and no professional/technical split. What changes the payment is where the service happens: the place of service on the claim decides whether Medicare pays the office or the facility rate.

99281 compared with similar codes

How to choose

99282ED visitStraightforward MDM

Use 99281 for an ED service that may not require a physician or qualified health care professional to be present. Use 99282 when the encounter meets that code's medical decision-making criteria.

99283Emergency department visitLow medical decision making

99283 represents an ED service supported by low medical decision making. 99281 is the distinct lower-level service that may not require a physician or qualified health care professional to be present.

99284Emergency department visitModerate medical decision making

99284 requires support for moderate medical decision making in the ED. Do not select it for a service that supports only the limited scope represented by 99281.

Codes related to 99281

Related codes aren’t interchangeable: bill the code that matches the service performed.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Open CMS sourceHow we calculate rates