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CPT code 99283: Emergency department visit, low medical decision making2026 Medicare rate & RVUs

Physician or qualified health professional evaluation in a hospital emergency department for a new or established patient when the documented medical decision making is low.

CMS RVU26DEffective Oct 1, 2026109 payment localities981.8K Medicare services in 2024

Medicare pays $69.47 for 99283 nationally in a facility.

Medicare rate · 99283

Emergency department visit, low medical decision making

Office or facility?

Work RVUs
1.6
Total RVUs
2.08
Global days
XXX

National rate · 2026

$69.47

Facility setting, before claim adjustments.

See every locality for 99283 →Billed by an NP, PA or therapist? →

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

Your location

Medicare pays by the payment locality where the service is performed.

On this page 10 sections
  1. Medicare rate
  2. What 99283 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

What 99283 covers

An emergency physician, nurse practitioner, or physician assistant evaluates and manages the patient in an organized hospital emergency department available for unscheduled care around the clock. An uncomplicated sprain, a stable chronic illness, or two self-limited problems can contribute to low problem complexity, but the presenting problem alone does not establish the visit level. The clinician's assessment, diagnostic decisions, and treatment plan determine the documented medical decision making.

Select 99283 when at least two of the three medical decision-making elements—problems, data, and management risk—meet or exceed the low level. Limited data can be supported by two unique tests ordered or reviewed, or by an assessment requiring an independent historian. Total time and new-versus-established status do not select the ED level. Document the problems addressed, relevant data, and management decisions. A laceration repair may be reported separately; append modifier 25 to 99283 only when the ED evaluation is significant and separately identifiable from the usual assessment for the repair. The hospital's facility service is billed separately from the clinician's professional visit.

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 99283 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

99283 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$65.41
AlaskaUnavailable$93.80
ArizonaUnavailable$68.22
ArkansasUnavailable$64.92
Atlanta, GAUnavailable$71.13
Austin, TXUnavailable$69.36
Bakersfield, CAUnavailable$68.78
Baltimore area, MDUnavailable$72.59
Beaumont, TXUnavailable$68.16
Brazoria, TXUnavailable$68.35

99283 rates by state

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

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Explore a state

Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

View every state and territory as a table
99283 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

How the 99283 rate is calculated

Each of 99283’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 · 99283

RVUs × geographic indexes × conversion factor

Office or facility?

Work1.60

1.60 RVUs× 1.000 GPCI

Practice expense0.28

0.28 RVUs× 1.000 GPCI

Malpractice0.20

0.20 RVUs× 1.000 GPCI

Adjusted RVUs

2.0800

Conversion factor

$33.4009

Medicare rate

$69.47

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

Payment rules and modifiers for 99283

99283 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 · 99283

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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99283 isn’t priced in this setting.

99283 compared with similar codes

Compare codes · National

5 codes, side by side

Office or facility?

  • 99283

    Emergency department visit, low medical decision making1.6 wRVU

    Not priced

  • 99282

    ED visit, straightforward MDM0.93 wRVU

    Not priced

  • 99284

    Emergency department visit, moderate medical decision making2.74 wRVU

    Not priced

  • 99213

    Office visit, established patient, low complexity1.3 wRVU

    $95.19

  • 99221

    Initial hospital care, straightforward or low MDM, 40 minutes1.63 wRVU

    Not priced

How to choose

99282ED visitStraightforward MDM
99282 fits straightforward medical decision making; 99283 requires at least two medical decision-making elements at the low level. An acute uncomplicated injury can support low problem complexity, but the other documented elements determine the visit level.
99284Emergency department visitModerate medical decision making
99284 requires at least two medical decision-making elements at the moderate level. An acute illness with systemic symptoms, prescription drug management, or independent interpretation of a test may support a moderate element, but one such element alone does not establish 99284.
99213Office visitEstablished patient, low complexity
99213 is a low-level established patient office or outpatient visit that may be selected by time or medical decision making. 99283 is for a hospital emergency department visit and is selected by medical decision making.
99221Initial hospital careStraightforward or low MDM, 40 minutes
When the same physician provides ED care and admits the patient to inpatient or observation status that day, include the ED work in the initial hospital service rather than separately reporting 99283. Report 99221 only if that level is supported.

Codes related to 99283

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

Codes related to 99283
CodeHow it relatesNational office range
Same family
99281ED visit, may not require physician presenceLowest ED level, for visits that may not need physician or qualified health professional involvement.No office rate
99282ED visit, straightforward MDMLower ED level requiring straightforward medical decision making.No office rate
99284Emergency department visit, moderate medical decision makingNext higher ED level requiring moderate medical decision making.No office rate
99285ED visit, high complexity decision makingHighest ED level requiring high medical decision making.No office rate
Often billed with
12001Simple wound repair, 2.5 cm or lessSimple repair of an eligible superficial wound up to 2.5 cm, when separately performed during the ED encounter.$99.63–$149.70
Used instead
99291Critical care, initial service, at least 30 minutesCritical care when documented critical illness and time support that service instead of routine ED care.$281.30–$386.53
99221Initial hospital care, straightforward or low MDM, 40 minutesInitial inpatient or observation care when the same physician admits the patient that day and this level is supported.No office rate

99283 billing questions

Can time be used to select 99283?

No. Select an emergency department visit level using medical decision making, not total time.

How do I decide between 99283 and 99284?

99283 requires at least two medical decision-making elements at the low level; 99284 requires at least two at the moderate level. Prescription drug management or an acute illness with systemic symptoms may support one moderate element, but neither alone establishes 99284.

Does 99283 require the patient to be new to the practitioner?

No. Emergency department visit codes cover both new and established patients, so patient status does not determine the level.

Can a laceration repair be billed with 99283 on the same date?

Yes, when the repair and a significant, separately identifiable ED evaluation are both performed. Report the repair separately and append modifier 25 to 99283 when the evaluation exceeds the usual assessment for that repair.

What if the same physician admits the patient after the ED visit?

For an inpatient or observation admission on the same date by that physician, include the ED work in the initial hospital service rather than reporting a separate 99283. Select the initial hospital level supported by its documentation.

Can 99283 be reported for an urgent care center or an office visit after hours?

No. The ED visit code requires an organized hospital emergency department available 24 hours a day; an urgent care or office encounter is coded according to its actual setting.

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
RVUs for 99283PPRRVU2026_Oct_nonQPP.csv, line 13,039 (RVU26D)

Open CMS sourceHow we calculate rates

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