CPT 99284: ER visit, level 4. What Medicare pays and what to ask
99284 is the second-highest emergency department visit level. This page explains what it means, what Medicare's national rate is, and what to ask if the charge looks high.
What this code means
CPT 99284 is used for an emergency visit with moderate medical decision making: a problem that needs a real work-up but is less severe than the cases coded 99285.
As with every ER visit level, the code covers the evaluation and management only. Lab work, X-rays, IV fluids and medications appear as separate lines.
Why the bill can be much higher than the Medicare rate
Moving from level 3 to level 4 or 5 can change a bill a lot, so the level itself is worth a question.
A facility charge may appear in addition to the physician charge. The rate here covers the physician side only.
| If a line is billed at | It would be |
|---|---|
| 5x the Medicare rate | $591.20 |
| 10x the Medicare rate | $1,182.40 |
| 20x the Medicare rate | $2,364.80 |
The Medicare rate is a published benchmark, not a legal ceiling on what a provider may charge. Our free scan flags a line as worth a closer look when it is billed at more than 10 times the Medicare rate.
Questions worth asking before you pay
- Why was level 4 chosen for this visit?
- Is there a separate facility charge, and how is it calculated?
- Does the bill list another ER visit level for the same date?
Check every line against the official Medicare rates in about a minute. The scan is free.
Related codes
Source: Medicare Physician Fee Schedule (CMS, July 2026 release), national payment amount, non-facility setting. Last updated October 2026. This page is general information, not legal or medical advice. Rates change each year and a hospital bill can include charges that the benchmark does not cover.