CPT code 99284: Emergency department visit, moderate medical decision making2026 Medicare rate & RVUs in Maine
Report a level 4 emergency department visit when at least two medical decision-making elements support moderate complexity, regardless of whether the patient is new or established.
CMS doesn’t publish an office rate for 99284 in Maine.
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
On this page 9 sections
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.
Where 99284 pays more and less in Maine
| Payment locality | Office | Facility |
|---|---|---|
| Rest of Maine | Unavailable | $112.62 |
| Southern Maine, ME | Unavailable | $113.79 |
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.
How the rate is built · 99284
RVUs × geographic indexes × conversion factor
Work2.74
2.74 RVUs× 1.000 GPCI
Practice expense0.45
0.45 RVUs× 1.000 GPCI
Malpractice0.35
0.35 RVUs× 1.000 GPCI
Adjusted RVUs
3.5400
Conversion factor
$33.4009
Medicare rate
$118.24
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
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.
Place of service · 99284
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
POS 11 · non-facility rate · national
—
99284 isn’t priced in this setting.
99284 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 99283Emergency department visitLow medical decision making
- 99283 fits low MDM. An acute illness with systemic symptoms may support the moderate problems element for 99284, but a second MDM element must also reach moderate.
- 99285ED visitHigh complexity decision making
- 99285 requires two high MDM elements; a condition posing a threat to life or bodily function or a hospitalization decision may support one. For 99284, two elements must reach moderate, but not high.
- 99291Critical careInitial service, at least 30 minutes
- 99291 requires critical illness or injury and at least 30 minutes of qualifying critical care. Select 99284 by MDM when the critical care requirements are not met.
- 99222Initial hospital visitModerate MDM or 55 minutes
- When the same physician provides ED evaluation and initial inpatient or observation care on the same date, report the appropriate initial hospital care code, such as 99222, rather than a separate ED visit.
99284 billing questions
Can time be used to support 99284?
No. Emergency department visit levels are selected by medical decision making, so time spent does not determine the level.
What separates 99284 from 99285?
99284 requires moderate MDM; 99285 requires high MDM. At least two of the three MDM elements must support the selected level.
Does the ED visit need modifier 25 when a procedure is also performed?
Append modifier 25 to 99284 when the ED evaluation is significant and separately identifiable from the usual work of a minor procedure, such as a laceration repair. Report the procedure with its own code.
Can 99284 be billed if the same physician admits the patient to observation or inpatient status?
When the same physician provides ED evaluation and initial inpatient or observation care on the same date, include the ED work in the initial hospital care service rather than separately reporting 99284.
Does prescribing medication alone qualify for moderate risk?
Documented prescription drug management supports moderate risk, one of the three MDM elements. A second element—problems or data—must also meet moderate criteria for 99284.
Can a non-emergency physician report 99284?
Yes. A physician or qualified health care professional evaluating a patient in the emergency department may report an ED visit even if emergency medicine is not their specialty.
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
Fee sheets
Put 99284 and the rest of your codes on one sheet
Your codes at your locality, with payer contracts beside Medicare.
Build my fee sheet