CPT code 99281: ED visit, may not require physician presence2026 Medicare rate & RVUs in Massachusetts
Reports a limited emergency department evaluation or management service that may be furnished without a physician or other qualified health care professional present.
CMS doesn’t publish an office rate for 99281 in Massachusetts.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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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 in Massachusetts
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Boston, MA | Unavailable | $11.58 |
| Rest of Massachusetts | Unavailable | $11.04 |
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.
How the rate is built · 99281
RVUs × geographic indexes × conversion factor
Work0.25
0.25 RVUs× 1.000 GPCI
Practice expense0.05
0.05 RVUs× 1.000 GPCI
Malpractice0.03
0.03 RVUs× 1.000 GPCI
Adjusted RVUs
0.3300
Conversion factor
$33.4009
Medicare rate
$11.02
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
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.
Place of service · 99281
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
POS 11 · non-facility rate · national
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99281 isn’t priced in this setting.
99281 compared with similar codes
Compare codes · National
4 codes, side by side
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.
99281 billing questions
How does 99281 differ from 99282?
99281 describes an ED service that may not require a physician or qualified health care professional to be present. 99282 is the next level and is selected using its applicable medical decision-making criteria.
Can triage alone support 99281?
No. Triage alone does not establish that an ED evaluation and management service was furnished; document the assessment or care provided during the encounter.
What documentation supports 99281?
Record the reason for the ED visit and the evaluation or management work actually performed. The note should support an ED service at this level rather than a higher-level service.
Is 99281 selected by time?
The encounter documentation should describe the service furnished rather than rely on elapsed time alone.
Does 99281 represent the hospital facility charge?
On a Medicare physician claim, 99281 represents the professional ED service. The hospital reports its facility services through the applicable facility payment system.
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
Show the CMS file lines behind this rate
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