Emergency dept visit hi mdm
Emergency department visits requiring complex medical decision-making show a potential cost difference of $444 between Medicare facility rates ($168.85) and hospital outpatient rates ($613.10), making bill verification essential before payment.
About the analyst
Kevin Nyk analyzes hospital pricing data at BillRazor Research. He specializes in Medicare reimbursement patterns and chargemaster pricing across U.S. hospitals. Expertise: hospital pricing, Medicare rates, chargemaster analysis.
Code 99285 represents the highest level emergency department visit requiring extensive physician work and complex medical decision-making for critically ill or injured patients. This code applies when patients present with severe, life-threatening conditions requiring immediate intensive evaluation and management. From a billing perspective, 99285 charges approximately 14.0x the Medicare reimbursement rate, with potential differences of $3,600+ depending on the hospital facility.
No credit card required. Results in 60 seconds.
Facility rate
$169
National Medicare benchmark
Non-facility rate
$169
Office setting benchmark
Data sources
3
23 data points
Key insights for CPT 99285
Facility vs office setting
$0 differenceNon-facility setting is less expensive for this procedure
What this procedure costs across different settings
The same procedure can cost very different amounts depending on where it's performed. These are the Medicare-allowed amounts — what hospitals actually charge can be 3-10x higher.
| Setting | Medicare rate | vs lowest |
|---|---|---|
| Facility (physician office) | $169 | Lowest |
| Non-facility (office) | $169 | Lowest |
| Outpatient (APC) | $613 | +263% |
Got a bill with CPT 99285?
Upload your bill and our AI compares every line item against these exact benchmark rates. Free analysis in 60 seconds — you only pay if we find savings.
About this data
Rates shown are from the 2026 Medicare Physician Fee Schedule, Hospital Outpatient Prospective Payment System (OPPS), Ambulatory Surgery Center Payment System, Clinical Laboratory Fee Schedule, Durable Medical Equipment Fee Schedule, and CMS Inpatient Prospective Payment System (DRG weights). Regional adjustments use CMS Geographic Practice Cost Indices (GPCI). Hospital charges are from CMS Hospital Price Transparency machine-readable files. All data is publicly available under federal law (45 CFR Part 180).
This data is for informational purposes only and does not constitute medical or financial advice. Actual costs depend on insurance coverage, negotiated rates, and individual circumstances.
Related procedures
Related pricing data
Data: Medicare Physician Fee Schedule, CMS Inpatient PPS (IPPS), Outpatient PPS (OPPS), ASC Payment System, Clinical Lab Fee Schedule (CLFS), National Average Drug Acquisition Cost (NADAC). FY 2024 data. All publicly available from CMS.
Methodology: Facility rate applies when the procedure is performed in a hospital or ASC. Non-facility rate applies in a physician office. GPCI adjustments reflect regional cost-of-living differences.
This information is for educational purposes only and is not medical, financial, or legal advice. Actual costs depend on your insurance and provider. We recommend verifying costs directly with your provider. Full methodology · Terms of use