Emergency dept visit hi mdm vs Emergency dept visit low mdm
Side-by-side cost comparison of CPT 99285 and CPT 99283 (+147% difference)
CPT 99285
Emergency dept visit hi mdm
CategoryEvaluation & Management
Body SystemGeneral
Total RVU5.13
Medicare Rate$171
CPT 99283
Emergency dept visit low mdm
CategoryEvaluation & Management
Body SystemGeneral
Total RVU2.08
Medicare Rate$69
Cost Comparison by Setting
Medicare Facility CMS PFS 2026 national facility rate
99285
$171
99283
$69
Medicare Non-Facility CMS PFS 2026 non-facility (office) rate
99285
$171
99283
$69
Hospital Outpatient (OPPS) CMS OPPS hospital outpatient rate
99285
99283
Ambulatory Surgery Center CMS ASC surgery center rate
99285
99283
Est. Commercial (Low) Estimated commercial insurance (150% Medicare)
99285
$257
99283
$104
Est. Commercial (High) Estimated commercial insurance (250% Medicare)
99285
$428
99283
$174
Which One Do You Need?
CPT 99285: Emergency dept visit hi mdm
This is the higher-cost option in the Evaluation & Management category. It is a more complex procedure (higher RVU) requiring more physician work, time, or resources.
CPT 99283: Emergency dept visit low mdm
This is the lower-cost option in the Evaluation & Management category. It is a less complex procedure (lower RVU) typically requiring less time or fewer resources.
Your doctor determines which CPT code applies based on the specific clinical situation. This comparison is for informational purposes to help you understand the cost differences.