CPT code 99284: Emergency department visit, moderate medical decision making2026 Medicare rate & RVUs in Kentucky

In Kentucky, Medicare pays $115.58 for 99284 in a facility. There’s no office rate.

Check a contract rate as a % of Medicare · 99284 nationwide

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

What 99284 covers

In a hospital emergency department, a physician or other qualified health care professional evaluates an acute illness with systemic symptoms, an acute complicated injury, or a chronic illness with exacerbation when the overall medical decision making (MDM) is moderate. Emergency physicians commonly furnish this care, but another physician or qualified professional evaluating the patient in the ED may report an ED visit. The code is the same whether the patient is new or established. A presenting complaint, tests ordered, or discharge alone cannot establish the level.

Select the level by MDM, not time: at least two of the three elements—problems, data, and risk—must meet moderate criteria. Document the problems addressed, qualifying data, treatment decisions such as prescription drug management, and disposition reasoning. Do not count a separately billed ECG interpretation as independent interpretation for MDM data. Report a significant, separately identifiable ED evaluation with modifier 25 when a minor procedure, such as simple laceration repair, is also billed. If the same physician provides ED care and initial inpatient or observation care that date, report the initial hospital care instead of a separate ED 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.

How Kentucky compares for 99284

Across 109 of 109 payment localities, the facility rate for 99284 runs from $109.52 in Wisconsin to $159.73 in Alaska. Kentucky pays $115.58. The RVUs are the same everywhere; the geographic indexes change the dollars.

Every other payment area

99284 rates by state

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

See 99284 in every payment locality

How the 99284 rate is calculated

Each of 99284’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 99284

99284 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.

Codes related to 99284

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

How 99284 has changed in Kentucky

Price 99284 for an earlier date of service

Where the Kentucky rate applies

Kentucky is a Medicare payment area, not a city. Our Census mapping connects it to 553 cities and communities in Kentucky. Some span more than one payment area; confirm with the service ZIP.

• Adairville
• Ages
• Albany
• Alexandria
• Allen
• Allensville
• Anchorage
• Annville

Browse all communities in Kentucky

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