CMS RVU26D · Effective 2026-10-01
Physician or qualified health professional evaluation in a hospital emergency department for a new or established patient when the documented medical decision making is low. Compare 99283 office and facility rates across CMS payment localities in Connecticut.
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.
Connecticut 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.
No supported rate
$72.67
1 of 1 localities have a supported rate.
Payment area: Connecticut
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.
Evaluation and management
Physician or qualified health professional evaluation in a hospital emergency department for a new or established patient when the documented medical decision making is low.
An emergency physician, nurse practitioner, or physician assistant evaluates and manages the patient in an organized hospital emergency department available for unscheduled care around the clock. An uncomplicated sprain, a stable chronic illness, or two self-limited problems can contribute to low problem complexity, but the presenting problem alone does not establish the visit level. The clinician's assessment, diagnostic decisions, and treatment plan determine the documented medical decision making.
Select 99283 when at least two of the three medical decision-making elements—problems, data, and management risk—meet or exceed the low level. Limited data can be supported by two unique tests ordered or reviewed, or by an assessment requiring an independent historian. Total time and new-versus-established status do not select the ED level. Document the problems addressed, relevant data, and management decisions. A laceration repair may be reported separately; append modifier 25 to 99283 only when the ED evaluation is significant and separately identifiable from the usual assessment for the repair. The hospital's facility service is billed separately from the clinician's professional visit.
981.8K
Medicare services in 2024 · #146 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.
Office rates for Connecticut, from the same CMS release.
99282 fits straightforward medical decision making; 99283 requires at least two medical decision-making elements at the low level. An acute uncomplicated injury can support low problem complexity, but the other documented elements determine the visit level.
99284 requires at least two medical decision-making elements at the moderate level. An acute illness with systemic symptoms, prescription drug management, or independent interpretation of a test may support a moderate element, but one such element alone does not establish 99284.
99213 is a low-level established patient office or outpatient visit that may be selected by time or medical decision making. 99283 is for a hospital emergency department visit and is selected by medical decision making.
When the same physician provides ED care and admits the patient to inpatient or observation status that day, include the ED work in the initial hospital service rather than separately reporting 99283. Report 99221 only if that level is supported.
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
Office / nonfacility
Unavailable
Facility
$72.67
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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 99283 in Connecticut.
PPRRVU2026_Oct_nonQPP.csv
13,039
GPCI2026.csv
38
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.60 | × 1.020 | 1.6320 |
| Practice expense | 0.28 | × 1.077 | 0.3016 |
| Malpractice | 0.20 | × 1.210 | 0.2420 |
| Total RVUs | 2.1756 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Connecticut$72.67
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.6 | 1.02 |
| Practice expense | 0.28 | 1.077 |
| Malpractice | 0.2 | 1.21 |
(1.6 × 1.02 + 0.28 × 1.077 + 0.2 × 1.21) × $33.4009 = $72.67
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.
No. Select an emergency department visit level using medical decision making, not total time.
99283 requires at least two medical decision-making elements at the low level; 99284 requires at least two at the moderate level. Prescription drug management or an acute illness with systemic symptoms may support one moderate element, but neither alone establishes 99284.
No. Emergency department visit codes cover both new and established patients, so patient status does not determine the level.
Yes, when the repair and a significant, separately identifiable ED evaluation are both performed. Report the repair separately and append modifier 25 to 99283 when the evaluation exceeds the usual assessment for that repair.
For an inpatient or observation admission on the same date by that physician, include the ED work in the initial hospital service rather than reporting a separate 99283. Select the initial hospital level supported by its documentation.
No. The ED visit code requires an organized hospital emergency department available 24 hours a day; an urgent care or office encounter is coded according to its actual setting.
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.
