No office rate
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.
On this page
CMS RVU26D · Effective 2026-10-01
99285 ED visit Medicare reimbursement rates in Maine
High-level emergency department evaluation reported when the physician or qualified health care professional's assessment and management meet high medical decision-making requirements. Compare 99285 office and facility rates across CMS payment localities in Maine.
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 99285 in Maine?
Maine has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$163.55–$165.24
2 of 2 localities have a supported rate.
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 99285: Emergency department visit, high medical decision making
High-level emergency department evaluation reported when the physician or qualified health care professional's assessment and management meet high medical decision-making requirements.
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.
Where the value comes from
- Work RVU4.00 · 78%
- Practice expense (office) RVU0.65 · 13%
- Malpractice RVU0.48 · 9%
9.1M
Medicare services in 2024 · #23 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.
99285 compared with similar codes
Office rates for Maine, from the same CMS release.
$291.69–$302.00
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.
No office rate
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.
No office rate
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.
Compare 99285 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.
2 of 2 payment localities
Rest Of Maine →
Office / nonfacility
Unavailable
Facility
$163.55
Southern Maine →
Office / nonfacility
Unavailable
Facility
$165.24
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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 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.
13,03899282,,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
13,04499292,,Critical care addl 30 min,A,,2.25,1.53,,0.52,,0.23,4.01,3.00,0,ZZZ,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00