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CPT code 99285: ED visit, high complexity decision making2026 Medicare rate & RVUs

High-level emergency department evaluation reported when the physician or qualified health care professional's assessment and management meet high medical decision-making requirements.

CMS RVU26DEffective Oct 1, 2026109 payment localities9.1M Medicare services in 2024

Medicare pays $171.35 for 99285 nationally in a facility.

Medicare rate · 99285

ED visit, high complexity decision making

Office or facility?

Work RVUs
4
Total RVUs
5.13
Global days
XXX

National rate · 2026

$171.35

Facility setting, before claim adjustments.

See every locality for 99285 →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 99285 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 99285 covers

Emergency physicians and qualified health care professionals use this level for emergency department assessments involving high medical decision making. Chest pain concerning for acute coronary syndrome, new focal neurologic deficits, suspected sepsis, and acute respiratory distress may prompt complex diagnostic and disposition decisions, but the presentation alone does not establish the level. The service includes a clinically appropriate history and examination in a hospital emergency department; it does not depend on whether the patient is new or established.

Select this level when at least two of three medical decision-making elements—problems addressed, data reviewed and analyzed, and management risk—meet the high threshold. High data complexity requires two qualifying data categories, such as independent test interpretation plus discussion of management with an external clinician; a hospitalization decision can support high risk. Document the problems addressed, relevant orders or results, data analysis, and treatment or disposition decisions. Time does not determine the ED visit level. If the same practitioner also furnishes initial inpatient or observation care that date, report only the initial hospital care service. A distinct earlier ED visit may be reported with subsequent critical care when separately documented.

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 99285 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

99285 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$161.67
AlaskaUnavailable$232.36
ArizonaUnavailable$168.36
ArkansasUnavailable$160.51
Atlanta, GAUnavailable$175.32
Austin, TXUnavailable$171.05
Bakersfield, CAUnavailable$169.70
Baltimore area, MDUnavailable$178.87
Beaumont, TXUnavailable$168.25
Brazoria, TXUnavailable$168.69

99285 rates by state

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

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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
99285 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 99285 rate is calculated

Each of 99285’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 · 99285

RVUs × geographic indexes × conversion factor

Office or facility?

Work4.00

4.00 RVUs× 1.000 GPCI

Practice expense0.65

0.65 RVUs× 1.000 GPCI

Malpractice0.48

0.48 RVUs× 1.000 GPCI

Adjusted RVUs

5.1300

Conversion factor

$33.4009

Medicare rate

$171.35

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

Payment rules and modifiers for 99285

99285 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 · 99285

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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99285 isn’t priced in this setting.

99285 compared with similar codes

Compare codes · National

5 codes, side by side

Office or facility?

  • 99285

    ED visit, high complexity decision making4 wRVU

    Not priced

  • 99284

    Emergency department visit, moderate medical decision making2.74 wRVU

    Not priced

  • 99291

    Critical care, initial service, at least 30 minutes4.5 wRVU

    $308.96

  • 99223

    Initial hospital visit, high decision making or 75 minutes3.5 wRVU

    Not priced

  • 99283

    Emergency department visit, low medical decision making1.6 wRVU

    Not priced

How to choose

99284Emergency department visitModerate medical decision making
Choose 99285 when at least two MDM elements meet the high threshold. A life-threatening problem or hospitalization decision can support one element; moderate MDM supports 99284.
99291Critical careInitial service, at least 30 minutes
Critical care requires at least 30 minutes of qualifying care for critical illness or injury with a high probability of imminent or life-threatening deterioration. Code 99285 is selected by MDM, not time.
99223Initial hospital visitHigh decision making or 75 minutes
When the same practitioner provides an ED visit and initial inpatient or observation care on the same date, report initial hospital care rather than both services; use 99223 only when its level criteria are met.
99283Emergency department visitLow medical decision making
Code 99283 reflects low medical decision making in the ED. Code 99285 requires high complexity in at least two MDM elements, regardless of visit duration.

Codes related to 99285

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

Codes related to 99285
CodeHow it relatesNational office range
Same family
99284Emergency department visit, moderate medical decision makingED visit selected for moderate rather than high medical decision making.No office rate
99283Emergency department visit, low medical decision makingED visit selected for low medical decision making.No office rate
99282ED visit, straightforward MDMED visit selected for straightforward medical decision making.No office rate
Used instead
99291Critical care, initial service, at least 30 minutesCritical care for qualifying critical illness or injury; distinct earlier ED care may also be reported.$281.30–$386.53
99223Initial hospital visit, high decision making or 75 minutesHigh-level initial hospital care when the same practitioner admits the patient that date and selection criteria are met.No office rate
Often billed with
93010ECG interpretation, interpretation and report onlySeparately documented ECG interpretation and report may accompany the ED visit.$7.86–$11.19

99285 billing questions

Can time be used to support this level?

No. ED visits are leveled by medical decision making, so a long stay alone does not support 99285. Documentation must establish high complexity in at least two of the three MDM elements.

What distinguishes this level from the moderate-complexity ED visit?

Choose 99285 when at least two MDM elements meet the high threshold; an acute threat to life or a hospitalization decision can support one element but does not establish the level alone. Choose 99284 when the documented MDM is moderate.

Can critical care be reported on the same date by the same provider?

Yes, if a medically necessary ED visit occurs before the patient requires critical care and the services are distinct. Append modifier 25 to the ED visit, document the separate services, and exclude the visit's work from critical care time.

What happens if the ED physician admits the patient?

When the same practitioner provides the ED service and initial inpatient or observation care on the same date, report only the initial hospital care service. Practitioners in the same group and specialty are treated as the same physician for this purpose.

Is ECG interpretation bundled into this visit?

A medically necessary, separately documented ECG interpretation and report may be reported with 93010. An interpretation billed separately cannot also count as independent test interpretation in the visit's data element.

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 99285PPRRVU2026_Oct_nonQPP.csv, line 13,041 (RVU26D)

Open CMS sourceHow we calculate rates

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