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

In Virginia, Medicare pays $166.26 for 99285 in a facility. There’s no office rate.

Check a contract rate as a % of Medicare · 99285 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 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.

How Virginia compares for 99285

Across 109 of 109 payment localities, the facility rate for 99285 runs from $159.34 in Wisconsin to $232.36 in Alaska. Virginia pays $166.26. The RVUs are the same everywhere; the geographic indexes change the dollars.

Every other payment area

99285 rates by state

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

See 99285 in every payment locality

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.

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.

Codes related to 99285

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

How 99285 has changed in Virginia

Price 99285 for an earlier date of service

Where the Virginia rate applies

Virginia is a Medicare payment area, not a city. Our Census mapping connects it to 628 cities and communities in Virginia. Some span more than one payment area; confirm with the service ZIP.

• Abbs Valley
• Abingdon
• Accomac
• Adwolf
• Afton
• Alberta
• Aldie
• Allison Gap

Browse all communities in Virginia

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