No office rate
Use 99281 for an ED service that may not require a physician or qualified health care professional to be present. Use 99282 when the encounter meets that code's medical decision-making criteria.
On this page
CMS RVU26D · Effective 2026-10-01
99281 ED visit Medicare reimbursement rates in Alabama
Reports a limited emergency department evaluation or management service that may be furnished without a physician or other qualified health care professional present. Compare 99281 office and facility rates across CMS payment localities in Alabama.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 99281 in Alabama?
Alabama has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$10.38
1 of 1 localities have a supported rate.
Payment area: Alabama
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Emergency medicine
About 99281: Lowest-level emergency department evaluation
Reports a limited emergency department evaluation or management service that may be furnished without a physician or other qualified health care professional present.
99281 is the lowest-level emergency department evaluation and management service. It covers an ED encounter whose care may not require a physician or other qualified health care professional to be physically present. It is specific to the emergency department setting; an office visit or an inpatient hospital service is not reported with this code. Triage by itself does not establish that an ED evaluation and management service was furnished.
Document the reason for the visit, the assessment or care provided, and why the encounter supports this level rather than a higher ED service. Unlike 99282–99285, 99281 is not distinguished by a stated medical decision-making level in its descriptor. On a Medicare physician claim, it is valued under the Physician Fee Schedule as a professional service; the hospital reports its facility services through the applicable facility payment system. The CMS facts supplied list no special payment rules for this code.
Where the value comes from
- Work RVU0.25 · 76%
- Practice expense (office) RVU0.05 · 15%
- Malpractice RVU0.03 · 9%
5.8K
Medicare services in 2024 · #1776 by national volume
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.
99281 compared with similar codes
Office rates for Alabama, from the same CMS release.
No office rate
99283 represents an ED service supported by low medical decision making. 99281 is the distinct lower-level service that may not require a physician or qualified health care professional to be present.
No office rate
99284 requires support for moderate medical decision making in the ED. Do not select it for a service that supports only the limited scope represented by 99281.
Compare 99281 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Alabama →
Office / nonfacility
Unavailable
Facility
$10.38
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 99281 in Alabama.
PPRRVU2026_Oct_nonQPP.csv
13,037
- Code
- 99281
- Physician work
- 0.25
- Practice expense
- 0.05
- Malpractice
- 0.03
GPCI2026.csv
4
- Locality
- Alabama
- Physician work
- 1.000
- Practice expense
- 0.875
- Malpractice
- 0.566
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.25 | × 1.000 | 0.2500 |
| Practice expense | 0.05 | × 0.875 | 0.0438 |
| Malpractice | 0.03 | × 0.566 | 0.0170 |
| Total RVUs | 0.3107 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Alabama$10.38
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0.25 | 1 |
| Practice expense | 0.05 | 0.875 |
| Malpractice | 0.03 | 0.566 |
(0.25 × 1 + 0.05 × 0.875 + 0.03 × 0.566) × $33.4009 = $10.38
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
99281 billing questions
How does 99281 differ from 99282?
99281 describes an ED service that may not require a physician or qualified health care professional to be present. 99282 is the next level and is selected using its applicable medical decision-making criteria.
Can triage alone support 99281?
No. Triage alone does not establish that an ED evaluation and management service was furnished; document the assessment or care provided during the encounter.
What documentation supports 99281?
Record the reason for the ED visit and the evaluation or management work actually performed. The note should support an ED service at this level rather than a higher-level service.
Is 99281 selected by time?
The supplied code facts do not specify a time threshold for 99281. The encounter documentation should describe the service furnished rather than rely on elapsed time alone.
Does 99281 represent the hospital facility charge?
On a Medicare physician claim, 99281 represents the professional ED service. The hospital reports its facility services through the applicable facility payment system.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
13,03499253,,Ip/obs cnsltj new/est low 45,I,+,2.00,0.84,NA,0.84,,0.12,2.96,2.96,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
13,03599254,,Ip/obs cnsltj new/est mod 60,I,+,2.72,1.23,NA,1.23,,0.17,4.12,4.12,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
13,03699255,,Ip/obs consltj new/est hi 80,I,+,3.86,1.44,NA,1.44,,0.23,5.53,5.53,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
13,03799281,,Emr dpt vst mayx req phy/qhp,A,,0.25,0.05,NA,0.05,,0.03,0.33,0.33,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,03899282,,Emergency dept visit sf mdm,A,,0.93,0.17,NA,0.17,,0.11,1.21,1.21,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,03999283,,Emergency dept visit low mdm,A,,1.60,0.28,NA,0.28,,0.20,2.08,2.08,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,04099284,,Emergency dept visit mod mdm,A,,2.74,0.45,NA,0.45,,0.35,3.54,3.54,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1ADDENDUM E. FINAL CY 2026 GEOGRAPHIC PRACTICE COST INDICES (GPCIs) BY STATE AND MEDICARE LOCALITY,,,,,,
2,,,,,,
3Medicare Administrative Contractor (MAC),State,Locality Number,Locality Name,2026 PW GPCI (with 1.0 Floor)***,2026 PE GPCI,2026 MP GPCI
410112,AL,00,ALABAMA,1.000,0.875,0.566
502102,AK,01,ALASKA*,1.500,1.065,0.551
603102,AZ,00,ARIZONA,1.000,0.969,0.856
707102,AR,13,ARKANSAS,1.000,0.859,0.515