No office rate
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.
On this page
CMS RVU26D · Effective 2026-10-01
99284 Emergency department visit Medicare reimbursement rates in Guam
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. Compare 99284 office and facility rates across CMS payment localities in Guam.
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 99284 in Guam?
Guam 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
$115.38
1 of 1 localities have a supported rate.
Payment area: Hawaii, Guam
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
About 99284: Emergency department visit, moderate medical decision making
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.
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.
Where the value comes from
- Work RVU2.74 · 77%
- Practice expense (office) RVU0.45 · 13%
- Malpractice RVU0.35 · 10%
4.5M
Medicare services in 2024 · #46 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.
99284 compared with similar codes
Office rates for Guam, from the same CMS release.
No office rate
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.
$322.12
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.
No office rate
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.
Compare 99284 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
Hawaii, Guam →
Office / nonfacility
Unavailable
Facility
$115.38
Need rates for a whole code list?
Fee-sheet and API access are in early access. Tell us which codes and locations your team needs.
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 99284 in Hawaii, Guam.
PPRRVU2026_Oct_nonQPP.csv
13,040
- Code
- 99284
- Physician work
- 2.74
- Practice expense
- 0.45
- Malpractice
- 0.35
GPCI2026.csv
46
- Locality
- Hawaii, Guam
- Physician work
- 1.000
- Practice expense
- 1.137
- Malpractice
- 0.579
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 2.74 | × 1.000 | 2.7400 |
| Practice expense | 0.45 | × 1.137 | 0.5117 |
| Malpractice | 0.35 | × 0.579 | 0.2026 |
| Total RVUs | 3.4543 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Hawaii, Guam$115.38
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.74 | 1 |
| Practice expense | 0.45 | 1.137 |
| Malpractice | 0.35 | 0.579 |
(2.74 × 1 + 0.45 × 1.137 + 0.35 × 0.579) × $33.4009 = $115.38
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.
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 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.
13,03799281,,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
13,04199285,,Emergency dept visit hi mdm,A,,4.00,0.65,NA,0.65,,0.48,5.13,5.13,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,04299288,,Direct advanced life support,B,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
13,04399291,,Critical care first hour,A,,4.50,4.29,,1.00,,0.46,9.25,5.96,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4309102,FL,99,REST OF FLORIDA,1.000,0.956,1.503
4410212,GA,01,ATLANTA,1.003,1.016,1.201
4510212,GA,99,REST OF GEORGIA,1.000,0.892,1.192
4601212,HI,01,"HAWAII, GUAM",1.000,1.137,0.579
4702202,ID,00,IDAHO,1.000,0.920,0.473
4806102,IL,16,CHICAGO,1.007,1.005,2.295
4906102,IL,12,EAST ST. LOUIS,1.000,0.920,2.014