CPT code 99283: Emergency department visit, low medical decision making2026 Medicare rate & RVUs in Texas
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 doesn’t publish an office rate for 99283 in Texas.
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 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 in Texas
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin, TX | Unavailable | $69.36 |
| Beaumont, TX | Unavailable | $68.16 |
| Brazoria, TX | Unavailable | $68.35 |
| Dallas, TX | Unavailable | $68.97 |
| Fort Worth, TX | Unavailable | $68.96 |
| Galveston, TX | Unavailable | $68.69 |
| Houston, TX | Unavailable | $72.35 |
| Rest of Texas | Unavailable | $68.35 |
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
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
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.
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
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